Entrustable Professional Activities (EPAs): A Novel Framework in Medical Education

Document Type : Letter to the Editor


PhD Candidate in Medical Education, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran AND Faculty Member, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.



The goal of medical training is to ensure that the physicians, residents, and specialists who graduate can provide high-quality, safe care (with limited or no supervision). Competency-Based Medical Education (CBME), which has gained much importance recently, aims at reducing “false positive” decisions by graduating trainees in unsupervised practice (1, 2). CBME is accepted all over the world but is associated with challenges such as overly analytical and detailed frameworks, rather abstract and general competencies, and difficulty in assessment for clinical teachers (3, 4).
Problems in the workplace-based assessment of learners include generosity error (too high scores-failure to fail), halo (generalizing from observing a single feature), lack of reliability (not being reproducible across occasions or raters), unclear (and often non-existent) standards, observer/rater differences, and ratings relating either to proficiency, personal development, effort, or reference group performance. Therefore, it is necessary to achieve assessments that match responsibilities in patient care, preferably with a holistic, non-tick-box approach and integration, not separation, of competencies, which are, at the same time, practically feasible (5). Thus, the first step in the implementation of CBME is to determine the capabilities of the students (6).