Answer to "I know nothing about EPAs. Where can I find information?"


EPAs are units of professional practice (think of them as a tasks or bundles of tasks) that can be fully entrusted to a trainee, once he or she has demonstrated the necessary competence to execute this activity unsupervised. EPAs are the units that constitute what clinicians or other health professionals do as daily work. More specifically, they are part of essential professional work in a given context; are executable within a time frame; require adequate knowledge, skills and attitudes, generally acquired through training; are observable and measurable in their process and their output of professional labour; are usually confined to qualified personnel; are independently executable (i.e. not necessarily part of a bigger EPA); require one or more competencies if an educational program has defined such competencies; and are amenable to entrustment decisions (ten Cate, 2005; ten Cate et al., 2015; Post et al., 2016; Taylor et al., 2017; Tekian, 2017). EPAs do not replace competencies, but they connect competencies to everyday clinical practice.

EPAs can be used to define the outcomes of a training program.  As such, EPAs can be a framework for workplace-based assessments, advancement decisions, and curriculum design.

For those new to the concept of EPAs, these are some useful references.

  • A one-page introduction: (ten Cate, 2014)

  • A two-page introduction: (ten Cate, 2013)

  • A more comprehensive introduction (6-7 text pages): (ten Cate, 2018)

  • A longer, comprehensive text (17 pages of text): (ten Cate et al., 2015)

  • The original brief paper (2 pages) introducing EPAs: (ten Cate, 2005)

  • The most highly cited paper introducing EPAs (6 pages): (ten Cate and Scheele, 2007)

In addition, these are some recommended videos (from the many that can be found online):

Dutch Federation of Medical Specialists Animation explaining EPAs for postgraduate training:

Animation explaining EPAs from the College of Anesthetists of Ireland EPA Team:

A series of 5 online explanations by the Association of Directors of Psychiatric Residency Training, all about EPAs:

Googling “EPA 101 University of Toronto” will provide you with a series of animated explanations about EPAs for Urology, Internal Medicine, Surgery, Pediatrics, Medical Oncology, Otolaryngology and Anesthesia from the University of Toronto


ten Cate, O. (2005) ‘Entrustability of professional activities and competency-based training’, Medical Education, 39(12), pp. 1176–1177.

ten Cate, O. (2013) ‘Nuts and Bolts of Entrustable Professional Activities’, Journal of Graduate Medical Education, 5(1), pp. 157–158.

ten Cate, O. (2014) ‘AM Last Page: What Entrustable Professional Activities Add to a Competency-Based Curriculum’, Academic Medicine, 89(4), p. 691.

ten Cate, O., Chen, H. C., Hoff, R. G., Peters, H., et al. (2015) ‘Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99’, Medical Teacher, 37(11), pp. 983–1002.

ten Cate, O (2018) ‘A primer on entrustable professional activities’, Korean Journal of Medical Education, 30(1), pp. 1–10.

ten Cate, O. and Scheele, F. (2007) ‘Viewpoint: Competency-Based Postgraduate Training: Can We Bridge the Gap between Theory and Clinical Practice?’, Academic Medicine, 82(6), p. 542.

Post, J. A., Wittich, C. M., Thomas, K. G., Dupras, D. M., et al. (2016) ‘Rating the Quality of Entrustable Professional Activities: Content Validation and Associations with the Clinical Context’, Journal of General Internal Medicine, 31(5), pp. 518–523.

Taylor, D. R., Park, Y. S., Egan, R., Chan, M.-K., et al. (2017) ‘EQual, a Novel Rubric to Evaluate Entrustable Professional Activities for Quality and Structure’, Academic Medicine, 92(11S), p. S110.

Tekian, A. (2017) ‘Are all EPAs really EPAs?’, Medical Teacher, 39(3), pp. 232–233.

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