The Promise and Challenge of Entrustable Professional Activities

Abstract

* Abbreviations: CBME — : Competency-based Medical Education EPA — : Entrustable Professional Activity The competency-based medical education (CBME) framework for training pediatric subspecialists, endorsed by the American Board of Pediatrics Subspecialty Training Task Force, represents a transformative change.1 Some may ask, “Why do we need to change?” External forces are major drivers, but medicine and the delivery of health care have changed over the past 2 decades, requiring new skills for physicians.2 MedPAC, the Macy Foundation, and Congress are calling for accountability for tax dollars invested in Graduate Medical Education.3,4 CBME has the potential to standardize outcomes to provide accountability by producing physicians who are better prepared to meet 21st century needs. Importantly, CBME has the potential to eliminate the current time-based or “seat-time” model of education, allowing trainees to progress and take on additional responsibilities as soon as they demonstrate competence. Although this may seem like an unattainable Utopia, we believe it is possible. We advocate the use of Entrustable Professional Activities (EPAs) as a framework to help supervisors decide when trainees are ready for unsupervised practice. With EPAs, increased entrustment of the trainee to independently perform clinical care occurs as they … Address correspondence to Joseph Gilhooly, MD, 707 SW Gaines St, Mail Code CDRC-P, Portland OR, 97239. E-mail: gilhooly{at}ohsu.edu