Entrustable Professional Activities

Recently a projected was conducted aimed to clarify the outcomes to be achieved by doctors completing the intern training in Ireland. The project had recommended that the Medical Council adopt an EPA model for defining what it expects doctors to achieve by the end of intern training.

An EPA is a core unit of professional practice that can be fully entrusted to a trainee as soon as he or she has demonstrated the necessary competence to execute the activity unsupervised. EPAs are related to competencies since they are concerned with the integration and application of multiple competencies in day-to-day practice; furthermore, EPAs introduce the concepts of supervision, proficiency and entrustment which are integral to the training process.

The use of EPAs has been described in academic literature as a useful tool in aiding medical training in developing competencies in those receiving training. It may also be helpful in allowing supervisors to better judge the competency of interns in the performance of certain tasks. Overall, it has also been found that greater intern responsibility for patient care can prove a powerful motivational tool for learning amongst interns, which can improve learning outcomes, provided this is coupled with an accessible and effective supervisory structure, suggesting an EPA-based approach to training has the potential to raise trainee motivation.

A draft list of EPAs has been identified and is now being considered by the Medical Council as the framework for describing what doctors are expected to achieve at the end of intern training. This EPA framework will become central to all decisions about planning, organising, delivering and evaluating intern training in Ireland and will be used to assess individual interns so as to determine if they can be issued a certificate of experience.

1.       Clerk a patient

2.       Request and interpret basic investigations

3.       Perform essential procedural skills

4.       Manages the work of in-patient care

5.       Prescribe and monitor drugs and fluids

6.       Recognise and manage the deteriorating/acutely unwell patient

7.       Handover and discharge a patient

8.       Engage in personal and professional development (not an EPA)

The proposed EPA model will be used to revise the National Intern Training Programme and to devise a strengthened system for assessment and feedback to interns on their progress through intern training; that assessment system will underpin and inform the decision to award a certificate of experience to doctors who have successfully completed intern training and who can demonstrate that they have achieved what is expected by the Medical Council.