Describing Entrustable Professional Activities Is Merely the First Step

Abstract

The profession of pharmacy needs a core set of entrustable professional activities (EPAs)--not only to describe what pharmacists do but also to set expectations and guide future action. Entrustable professional activities are units of work. (1) They can be observed and assigned by preceptors and supervisors. Unlike competency statements, which can seem abstract and academic to noneducators, (2) EPAs are intuitively understood by patients, practitioners, and policymakers. The EPAs for New Pharmacy Graduates reported in this issue of the Journal are an important first step, but far more needs to be done. (3) Entrustable professional activities were first described and subsequently used by medical residency training programs as a means to translate competency statements (ie, general qualities that every health professional should possess) into concrete tasks that supervisors can observe and delegate to trainees in the clinical environment. (1) Discipline-specific EPAs have been formulated for postgraduate training in family medicine, internal medicine, and pediatrics. (4-6) In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 core EPAs for entering residency that medical school graduates are expected to perform without direct supervision on day 1 of residency, regardless of specialty. (7) The enthusiasm and speed with which EPAs have been embraced by medical schools and residency training programs suggests there has been a need for greater clarity regarding a core set of skills that all physicians should possess. Currently, 10 medical schools are pilot testing the AAMC core EPAs. (8) These institutions will formally report outcomes as well as lessons learned from implementing the EPA framework in their curricula. The development of the Core EPAs for New Pharmacy Graduates was rigorous. (9) Although input from a wide range of stakeholders was sought and received, undoubtedly some will view them with skepticism. To some, the EPAs represent yet another mandate that colleges and schools must somehow assimilate into their curricula and use to assess student progress. For others, the EPAs do not reflect their specialized areas of practice. And still others will have difficulty seeing the connection between the EPAs and the content they teach. These are legitimate concerns but miss the point. We argue that a lack of clarity regarding the role and responsibilities of pharmacists has hampered the advancement of pharmacy practice. Today the profession has a shared vision and model of practice. (10) The accreditation of doctor of pharmacy programs is contingent on producing practice-ready and team-ready graduates. (11) The Core EPAs for New Pharmacy Graduates reflect these realities. While the EPAs often are presented as a list of discrete tasks and activities, they are interrelated and over-lapping (Figure 1). Moreover, EPAs do not negate the need for a set of underlying competencies. (12) These competencies, which were derived from the cognitive, affective, and psychomotor domains, are articulated in the CAPE 2013 Educational Outcomes statements. (13) The EPA statements flow from and are extensions of these competencies (Figure 2). Moreover, the Core EPAs for New Pharmacy Graduates describe the foundation for the development of EPAs for postgraduate pharmacy training programs. New pharmacy graduates should be able to perform all Core EPAs without direct supervision. (9) This does not imply that new pharmacy graduates are fully formed and no longer will need feedback, guidance, or coaching from exemplary role models after graduation (Table 1). Postgraduate training, both formal and informal, in the workplace after licensure should be structured in a way that will enable new graduates to refine their skills, build their confidence, and increase their proficiency. (14) Over time, pharmacy graduates should be entrusted to assume greater autonomy and the responsibility of supervising others. …