One of the key changes of the revised NFPMT is the transition to a competency-based medical education model and the introduction of Entrustable Professional Activities (EPAs).  

EPAs are core clinical activities that demonstrate integrate the knowledge, skills, and attributes performed by prevocational doctors during their day-to-day clinical work. The clinical activity (the EPA) is observed and evaluated using an entrustment scaledescribing the degree of supervisor input required to execute the activity to standard. As EPAs are linked to daily work, they can be readily observed by senior medical staff, daytoday supervisors such as registrars, and potentially other health professionals (e.g. pharmacists for the prescribing EPA).

The four EPAs are: 

EPA 1 – Clinical assessment

Conduct a clinical assessment of a patient incorporating history, examination. And formulation of a differential diagnosis and a management plan, including appropriate investigations and communication with the patient and their family or carers.

EPA 2 – Recognition and care of the acutely unwell patient

Recognize, assess, escalate appropriately and provide immediate management to deteriorating and acutely unwell patients.

EPA 3 – Prescribing

Appropriately prescribe therapies (drugs, fluids, blood products, inhalation therapies including oxygen) tailored to patients’ needs and conditions.

EPA 4 – Team communication

Communicate about patient care, including accurate documentation and written and verbal information to facilitate high-quality care at transition points and referral.

EPA Requirements

Prevocational doctors must complete a minimum of 10 EPA assessments each year.

This includes:

  • Minimum of 2 EPAs each term
  • Minimum of 4 assessments of EPA1 (one each term)
  • Minimum of 2 assessments of EPA2, EPA3 and EPA4 across the year

EPA Assessors

To assess an EPA, Prevocational Supervisors will need to complete EPA training.

The AMC are in the process of developing an EPA training module.  

EPAs can be assessed by specialists, registrars, nurses/nurse practitioners, pharmacists, or other health professionals. At least one EPA in each term must be assessed by a specialist or equivalent.  

2024 PMCV EPA Implementation Trial

PMCV recognises 2024 as an opportunity for health services to commence engaging and familiarising prevocational supervisors and PGY1 doctors with EPAs in lead up to formal implementation in 2025. 

The EPA Implementation Trial aims to develop an informed statewide implementation strategy and resources to support the formal implementation of EPAs in 2025

The Trial will formally commence in Term 2 2024, and PMCV will post findings when they arise.

A number of Victorian health services have opted into the pilot program for 2024. These include:

  • Barwon Health
  • Bendigo Health
  • Eastern Health
  • Goulburn Valley Health
  • Grampians Health
  • Mercy Health
  • Monash Health
  • Northern Health
  • Royal Children’s Hospital

Resources

Infographic – EPA Assessment Process

Infographic – How EPAs will strengthen the training of prevocational doctors

Infographic – Providing feedback to prevocational doctors

Infographic – How EPAs will strengthen your prevocational training journey

EPA Assessment Forms

AMC Video – Introduction to EPAs

Additional Resources

ResourceAuthorLink
Presentation from NFPMT HS Lead WorkshopDr Sheree Conroy
Presentation- New Models of
Medical Training: A
Global Journey
Dr Jason Frank
Crossing the Gap: Using Competency-Based
Assessment to Determine Whether Learners Are
Ready for the Undergraduate-to-Graduate Transition

Murray et al., 2018

Learning Curves in Health Professions
Education

Pusic et al., 2015

The Ottawa Surgical Competency Operating
Room Evaluation (O-SCORE): A Tool to Assess
Surgical Competence

Gofton et al., 2012

How Do You Deliver a Good Obstetrician?
Outcome-Based Evaluation of Medical
Education

Asch et al., 2013