Answer to "How would one ensure that a past STAR awarded for a previously mastered EPA at level 4 remains valid"?


The issue behind this question seems to be: how do we ensure maintenance of competence by those who have received STARs? Of course, after graduation from the training program, it will be the responsibility of individuals and other regulatory bodies to ensure that professionals maintain as much knowledge, skills and experience as necessary for safe, high quality practice. But what an educational program can do for a STAR is to propose an expiration date ('valid thru..'). This means that trust is expressed in the learner for a period of time, which may be limited if the EPA is not being practiced. That period may be different for various EPAs, but after a phase of non-practice (or inadequate practice), supervision should be mandatory again (ten Cate et al., 2015; Touchie and Cate, 2016; Carraccio et al., 2017). A few activities that require certification and advanced skills already have expirations dates, such as Advanced Trauma Life Support or Pediatric Advanced Life Support. In 2013, Mehta and colleagues from the Cleveland Clinic Lerner College of Medicine (2013) were the first to suggest that EPA STARs (or badges) should have an expiration date.

This limitation, set at the time of the awarding of a STAR, would move the whole concept of EPAs from undergraduate and graduate medical education to professional practice. It has been speculated that every practising physician should have a 'dynamic portfolio of validated EPAs' and that, at any moment, EPAs that have not been practised should lose validity, while new EPAs may be added after adequate training and supervision (Touchie and Cate, 2016).

For instance, as noted by Mehta et al. (2013): "To support maintenance of skills, the specific badges could carry expiration dates. Also, as new processes and procedures become standard of care, the certification in women’s health would be updated with a need for additional badges. Thus, Jane may need to get new badges for ThinPrep testing and HPV vaccination to maintain her certification".


Carraccio, C., Englander, R., Gilhooly, J., Mink, R., et al. (2017) ‘Building a Framework of Entrustable Professional Activities, Supported by Competencies and Milestones, to Bridge the Educational Continuum’, Academic Medicine, 92(3), p. 324.

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.

Mehta, N. B., Hull, A. L., Young, J. B. and Stoller, J. K. (2013) ‘Just Imagine: New Paradigms for Medical Education’, Academic Medicine, 88(10), p. 1418.

Touchie, C. and Cate, O. ten (2016) ‘The promise, perils, problems and progress of competency-based medical education’, Medical Education, 50(1), pp. 93–100.