The recommended description of an entrustable professional activity: AMEE Guide No. 140

Figures & data

Figure 1. EPA – competency matrix.

Table 1. General features that enable trust in learners.

Agency	Proactive attitude towards work, team, safety and personal development that includes awareness of and responding to the need for action even when outside of the strict definition of one’s responsibilities and practice of adaptive expertise. Agency can manifest within the context of one or more of the other four factors
Reliability	Consistent, predictable, and conscientious behavior driven by a sense of accountability and responsibility
Integrity	Truthfulness, benevolence, and patient-centeredness, where expertise is employed to benefit patients and decisions are motivated by concern for and made in the best interest of patients
Capability	The ability to perform a specific task in a variety of contexts and within an appropriate time frame, requiring a reasonable understanding and overall view of the clinical situation and ability to communicate and work effectively with others within a system
Humility	Discernment of one’s limitations; willingness and ability to ask for help and feedback; receptivity to insights of patients and co-workers; and ability to learn and develop from mistakes, feedback, and the expertise of others

Table 2. Assessment tools suitable as sources of information in the workplace to inform EPA entrustment decisions.

Approaches	Methods	Tools
Watching	Brief and focused observation	Mini Clinical Examination exercise (mini-CEX); Direct observation of procedural skills (DOPS) (with or without video recording); in some cases insitu simulation (Patterson et al. 2013) or audio-based evaluation (Sanatani et al. 2020)
	Longitudinal observation	Multisource feedback (MSF) or 360^0 Evaluation
Talking	Brief conversations	Case-based discussions, Chart-Stimulated Recall, One-minute Preceptor, SNAPPS, Entrustment-based discussions
Reviewing results	Product evaluation	Entries in Electronic Health Record; Discharge letters; QI reports; Resident-Sensitive Quality Measures (RSQM)(Schumacher et al. 2018)

Figure 2. Decreasing levels of supervision needed, varying by EPA and by individuals.

Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. 2013. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 22(6):468–477.

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Sanatani M, Potvin K, Conter H, Trudgeon K, Warner A. 2020. Quality of written feedback given to medical students after introduction of real-time audio monitoring of clinical encounters. BMC Medical Educ. 20(236):1–9.

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Schumacher DJ, Holmboe ES, van der Vleuten C, Busari JO, Carraccio C. 2018. Developing resident-sensitive quality measures: amodel from pediatric emergency medicine. Acad Med. 93(7):1071–1078.

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