Distant and Hidden Figures: Foregrounding Patients in the Development, Content, and Implementation of Entrustable Professional Activities.

Abstract

Entrustable professional activities (EPAs) describe activities that qualified professionals must be able to perform to deliver safe and effective care to patients. The entrustable aspect of EPAs can be used to assess learners through documentation of entrustment decisions, while the professional activity aspect can be used to map curricula. When used as an assessment framework, the entrustment decisions reflect supervisory judgments that combine trainees' relational autonomy and patient safety considerations. Thus, the design of EPAs incorporates the supervisor, trainee, and patient in a way that uniquely offers a link between educational outcomes and patient outcomes. However, achieving a patient-centered approach to education amidst both curricular and assessment obligations, educational and patient outcomes, and a supervisor-trainee-patient triad is not simple nor guaranteed. As medical educators continue to advance EPAs as part of their approach to competency-based medical education, the authors share a critical discussion of how patients are currently positioned in EPAs. In this article, the authors examine EPAs and discuss how their development, content, and implementation can result in emphasizing the trainee and/or supervisor while unintentionally distancing or hiding the patient. They consider creative possibilities for how EPAs might better integrate the patient as finding ways to better foreground the patient in EPAs holds promise for aligning educational outcomes and patient outcomes.