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ABP position statement on EPAs

 7-17-17

Entrustable Professional Activities (EPAs) are currently being proposed or incorporated into residency training in numerous clinical subspecialties. EPAs were first proposed by ten Cate in 2005, and represent a way to implement an outcome-based model of acquisition of observable knowledge, skills, and attitudes by a learner. Per ten Cate, EPAs "are units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence." Furthermore, EPAs should be activities that define the practice of a specialty.

EPAs are being adopted into medical education as a means to define skills that must be mastered during training and thus must coordinate with other aspects of graduate medical education such as milestones, competencies, and graduated responsibilities. EPAs will likely become part of pathology residency training in the coming years. As such, EPAs will help to define training and evaluation during residency, and will be reflected in ACGME program recommendations and activities and oversight by residency program directors.

In April 2017, the ABP convened a meeting of Pathology GME experts to discuss EPAs. A recent publication (McCloskey et al) was reviewed and a potential pilot study was defined, encompassing four important and feasible EPAs in Anatomic and Clinical Pathology. These included completion of a nonforensic medical autopsy, an intraoperative diagnosis (i.e. frozen section), workup of a non-major transfusion reaction, and a clinical pathology diagnostic study, such as independent sign-out of ANCA or protein electrophoresis. The constitution of the working group to carry out this pilot was not defined, but should ultimately include representation from PRODS, APC, ACGME, and ABP.

As residency education gradually moves from a time-defined to competency-based training and evaluation process, assessment of completion of training and readiness for certification will require new measures. EPAs, if incorporated, would be of interest to the ABP as part of this process. While the ABP would not have a direct role in administration of or assessment using the EPAs, the outcome of EPAs is likely to have an impact on the ABP in terms of defining the successful completion of residency training and readiness for certification and independent practice. For example, it might be that residents are required to successfully complete a set of EPAs to be considered eligible for the certification exam; this may be an effective step away from current requirements such as number of months or the 50 autopsy minimum, to a more competency-based system.

The ABP supports and will participate in further development of the EPAs in pathology including a pilot project. Input into EPA expectations and outcome will be important to the ABP, but will most directly affect those responsible for residency training in pathology. A collaborative working group is recommended.