Entrustment decisions: Implications for curriculum development and assessment

Abstract

With increased interest in the use of entrustable professional activities (EPAs) in undergraduate and postgraduate medical education, comes questions about their implications for curriculum development and assessment. This paper addresses some of those questions, discussed at a symposium of the 2017 conference of AMEE, by presenting the components of an EPA, describing their importance and application, identifying their implications for assessment, and pinpointing some of challenges they pose in undergraduate and postgraduate settings. It defines entrustment, describes the three levels of trust, and presents trainee and supervisor factors that influence it as well as perceived benefits, and risks. Two aspects of EPAs have implications for assessment: units of professional practice and decisions based on entrustment, which impact an assessment’s blueprint, test methods, scores, and standards. In an undergraduate setting EPAs have great appeal, but work is needed to identify and develop a robust assessment system for core EPAs. At the postgraduate level, there is tension between the granularity of the competencies and the integrated nature of the EPAs. Even though work remains, EPAs offer an important step in the evolution of competency-based education.

Keywords:

• Written
• outcome-based
• postgraduate
• undergraduate
• medicine

Disclosure statement

The authors report no declaration of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Ara Tekian

Ara Tekian, PhD, MHPE, is Professor of Medical Education, the University of Illinois at Chicago, Department of Medical Education, Chicago, IL, USA.

Olle ten Cate

Olle ten Cate, PhD, is Professor of Medical Education, and Director of the Center for Research and Development of Education, University Medical Center Utrecht, The Netherlands.

Eric Holmboe

Eric Holmboe, MD, is Senior Vice President, Milestone Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, IL, USA.

Trudie Roberts

Trudie Roberts, MBChB, PhD, FRCP, FHEA, is the Director of Leeds Institute of Medical Education in Leeds, United Kingdom, and President of AMEE.

John Norcini

John Norcini, PhD, is the President and CEO of the Foundation for Advancement of International Medical Education and Research (FAIMER), in Philadelphia, PA, USA.