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Family Medicine Specialty Develops Entrustable Professional Activities

September 30, 2015–Family medicine organizations have developed Entrustable Professional Activities (EPAs) for Family Medicine End of Residency Training. The list of 20 EPAs collectively defines the type of care that the residency graduate can be trusted to deliver to the public. It also defines the expectations for the education of family physicians and integrates all of the core competencies, subcompetencies, and their specific milestones. The EPAs do not need to be reported; they are intended to be used on an individual program basis as part of evaluation tools that are ultimately used in Milestones assessment.

Family medicine is one of many specialties that use EPAs. EPAs define the critical activities that constitute a specialty and the elements that experts and the public consider to belong to that specialty. They also define the knowledge, skills, and attitudes that resident physicians must have before they graduate, and translate the core competencies into activities that physicians are expected to perform as part of their medical practice. It is understood that some graduates of family medicine residency programs will not practice the full breadth described in these EPAs, and that physicians in osteopathic-designated residencies will incorporate osteopathic principles and practice into their overall evaluation and treatment of patients.

The Entrustable Professional Activities for Family Medicine End of Residency Training 

  1. Provide a usual source of comprehensive, longitudinal medical care for people of all ages.
  2. Care for patients and families in multiple settings.
  3. Provide first-contact access to care for health issues and medical problems.
  4. Provide preventive care that improves wellness, modifies risk factors for illness and injury, and detects illness in early, treatable stages.
  5. Provide care that speeds recovery from illness and improves function.
  6. Evaluate and manage undifferentiated symptoms and complex conditions.
  7. Diagnose and manage chronic medical conditions and multiple co-morbidities.
  8. Diagnose and manage mental health conditions.
  9. Diagnose and manage acute illness and injury.
  10. Perform common procedures in the outpatient or inpatient setting.
  11. Manage prenatal, labor, delivery, and postpartum care.
  12. Manage end-of-life and palliative care.
  13. Manage inpatient care, discharge planning, transitions of care.
  14. Manage care for patients with medical emergencies.
  15. Develop trusting relationships and sustained partnerships with patients, families, and communities.
  16. Use data to optimize the care of individuals, families, and populations.
  17. 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.
  18. Advocate for patients, families, and communities to optimize health care equity and minimize health outcome disparities.
  19. Provide leadership within interprofessional health care teams.
  20. Coordinate care and evaluate specialty consultation as the condition of the patient requires.

The EPAs were developed by the Family Medicine for America’s Health Board of Directors at the request of family medicine organizations and leaders. These EPAs identify the clinical situations that trainees should be trusted to perform competently upon graduation, and will drive the content of a graduate medical education system that will educate a workforce equipped to deliver on the Triple Aim.

Input was sought during the formation of the EPAs from family medicine educators and the 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. The list was then reviewed by the leadership of the eight family medicine organizations, who provided final feedback and recommendations to the Family Medicine for America's Health Board of Directors.

To learn more about the EPAs and Family Medicine for America’s Health, visit Entrustable Professional Activities for Family Physicians. 

Copyright 2018 by Society of Teachers of Family Medicine