The Family Medicine for America's Health Board of Directors developed entrustable professional activities for family medicine.
What are Entrustable Professional Activities (EPAs)?
EPAs are the critical activities that constitute a specialty, and the elements that experts and society consider to belong to that specialty. EPAs are observable and measurable, lead to recognized outcomes, require integration of competencies across domains, and map to competencies and their Milestones.1 EPAs define the knowledge, skills, and attitudes that resident physicians must have before they graduate. EPAs are a way to translate the core competencies into the well-defined activities that physicians are expected to do as part of their practice of medicine.
Read about the nuts and bolts of Entrustable Professional Activities in the Journal of Graduate Medical Education.1
EPAs for Family Medicine End of Residency Training
The Entrustable Professional Activites are:
- Provide a usual source of comprehensive, longitudinal medical care for people of all ages.
- Care for patients and families in multiple settings.
- Provide first-contact access to care for health issues and medical problems.
- Provide preventive care that improves wellness, modifies risk factors for illness and injury, and detects illness in early, treatable stages.
- Provide care that speeds recovery from illness and improves function.
- Evaluate and manage undifferentiated symptoms and complex conditions.
- Diagnose and manage chronic medical conditions and multiple co-morbidities.
- Diagnose and manage mental health conditions.
- Diagnose and manage acute illness and injury.
- Perform common procedures in the outpatient or inpatient setting.
- Manage prenatal, labor, delivery and post-partum care.
- Manage end-of-life and palliative care.
- Manage inpatient care, discharge planning, transitions of care.
- Manage care for patients with medical emergencies.
- Develop trusting relationships and sustained partnerships with patients, families and communities.
- Use data to optimize the care of individuals, families and populations.
- In the context of culture and health beliefs of patients and families, use the best science to set mutual health goals and provide services most likely to benefit health.
- Advocate for patients, families and communities to optimize health care equity and minimize health outcome disparities.
- Provide leadership within interprofessional health care teams.
- Coordinate care and evaluate specialty consultation as the condition of the patient requires.
Why did we develop EPAs for family physicians?
Family Medicine for America’s Health, a $20+ million initiative of the family medicine organizations, sets expectations that patients can have of family medicine, and positions family medicine to create better health, better health care, and lower cost for patients and communities (the Triple Aim). To meet those expectations, both the specialty and the public need to understand and agree on how family medicine is defined and what should be expected of family physicians. EPAs “identify the clinical situations in which trainees should, upon graduation, be trusted to perform competently.”1 These EPAs will drive the content of a graduate medical education system that will educate a workforce equipped to deliver on the Triple Aim.
How do EPAs differ from competencies?
- EPAs are broader and more general than the Milestones.
- EPAs integrate competencies and the Milestones.
- "EPAs are not an alternative for competencies, but a means to translate competencies into clinical practice.”1
An example of how EPAs integrate with the Milestones and competencies
Note that other competencies, sub competencies and Milestones are also integral to assessing entustability in resident chronic care skills. This is just one example.
How will EPAs be used?
The goal is to incorporate the EPAs into residency training. "The goal of residency training in family medicine is to graduate family physicians who are ready to practice comprehensive continuing care... Programs have the responsibility to provide training that exposes learners to the full scope of family medicine and—through rigorous and ongoing assessment—to ensure that family medicine competencies are acquired and programmatic educational goals are met."2
All graduates of family medicine residency programs may not include all of the EPAs in their personal practice. The goal of training is for the graduate to be prepared for comprehensive, longitudinal care, even though some may not practice in that manner.
The American Board of Family Medicine (ABFM) board of directors hasn't yet had a formal discussion on the role of EPA's/Milestones in the certification process. ABFM has indicated that Diplomates will likely first see these in the context of the MC-FP Part II Self-Assessment Modules (SAMs). These competencies also serve as the structure for organizing the scoring process on the SAMs. Existing SAMS will probably not be retrofitted with competencies based on EPAs.
Do other specialties have EPAs?
Yes. Many specialties, including internal medicine and pediatrics, have or are working on EPAs.
Who developed the EPAs?
The EPAs were developed by the Family Medicine for America’s Health Board of Directors. Input was sought from those who educate family physicians: members of the Association of Family Medicine Residency Directors, the Association of Departments of Family Medicine, Society of Teachers of Family Medicine, and the North American Primary Care Research Group. Input was reviewed by the leadership of the family medicine organizations, who provided feedback and recommendations to the Family Medicine for America's Health Board of Directors.
What sources/background information were used for developing these EPAs?
- The 7 essential functions of primary care that improve outcomes and access, and lower costs (Starfield 2004-2005) (PDF)
- The Joint Principles of the Patient-Centered Medical Home (2007) (PDF)
- The benefits of implementing PCMH (PCPCC 2010, 2012) (PDF)
- The clinical epidemiology definition of the three levels of prevention (PDF)
- The role definition of the family physician FFM 2.0 (PDF)
- The entrustable professional activities of the University of Calgary
Will I need to report to the ACGME on EPAs, like I do for the Milestones?
The EPAs can be used on an individual program basis as part of evaluation tools that are ultimately used in Milestones assessment. While internal medicine and pediatrics formally use EPAs as part of their Milestones, the RC-FM has not yet discussed their formal use. The RC-FM will be discussing EPAs at a future meeting.
What is Family Medicine for America's Health?
Family Medicine for America’s Health is a new collaboration between the eight leading family medicine organizations in the United States to drive continued improvement of the U.S. health care system and demonstrate the value of true primary care. The collaboration includes:
Learn more about Family Medicine for America's Health.
- American Academy of Family Physicians
- American Academy of Family Physicians Foundation
- American Board of Family Medicine
- American College of Osteopathic Family Physicians
- Association of Departments of Family Medicine
- Association of Family Medicine Residency Directors
- North American Primary Care Research Group
- Society of Teachers of Family Medicine
- Olle ten Cate (2013) Nuts and Bolts of Entrustable Professional Activities. Journal of Graduate Medical Education: March 2013, Vol. 5, No. 1, pp. 157-158.
- Shaughnessy AF, Sparks J, Cohen-Osher M, Goodell KH, Sawin GL, Gravel J. Entrustable Professional Activities in Family Medicine. Journal of Graduate Medical Education 2013;5(1):112-118. doi:10.4300/JGME-D-12-00034.1.
- Oandasan I, Saucier D, eds. Triple C Competency-based Curriculum Report – Part 2: Advancing Implementation. Mississauga, ON: College of Family Physicians of Canada; 2013. www.cfpc.ca/uploadedFiles/Education/_PDFs/TripleC_Report_pt2.pdf