Answer to "EPAs, competencies and skills are not the same thing, but the distinction remains confusing for me. Please clarify."


Many people ask, for example, is "physical examination" a competency, a skill or an EPA?

EPAs are units of professional practice that can be conceived as tasks or responsibilities. EPAs constitute the description of work and are independent of persons. They operationally define a profession. They constitute the task list each clinical department, clinical ward, or health care worker may have for the day, for the week, or any period of time. Job descriptions can list EPAs in general terms, and task lists apply those to specific things that must occur in a plannable period of time.

In contrast, competencies describe persons. Trainees who become competent professionals must acquire competencies that include knowledge, skills, and attitudes (KSA). We usually speak of competencies when the combination of KSAs, in an integrated fashion allows, a person to carry out a task or activity well; we talk about features of individuals.

The matrix below includes three EPAs and seven competency domains (each of which can contain multiple competencies within the domain (Englander et al., 2013). Obtain a history is part of the first EPA. It definitely requires medical expertise, communication ability and professionalism.


Obtain a history or history taking is itself also an EPA as, without doubt, it is a professional activity. When keeping the use of language pure and precise, history taking is not a competency and it is not a skill. While lay people (and educators!) may use 'history taking' as a skill or competency, this is linguistically incorrect and, in fact, confusing. When using 'history taking' as skill or competency, people mean 'the ability of history taking'; i.e. as an abbreviation of a competency. In most competency frameworks 'competencies' are formulated sometimes as true competencies (i.e. descriptions of persons) and sometimes as activities. This may be a reason that many people become confused. Professionals can possess competencies; they can never possess EPAs (Englander et al., 2013; Englander and Carraccio, 2014; ten Cate et al., 2015).

In addition, it is important to think of EPAs as holistic units of work, not just as skills or competencies. It is not only the physical or mental skill that is important, but everything around it that makes an EPA a responsibility to be entrusted to a learner. Trust requires supervisors acknowledge not just trainee ability but also aspects of trainee integrity, reliability of behaviour and humility (i.e. willingness to ask for help if needed). See also FAQ #13 


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.

Englander, R., Cameron, T., Ballard, A. J., Dodge, J., et al. (2013) ‘Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians’, Academic Medicine, 88(8), p. 1088.

Englander, R. and Carraccio, C. (2014) ‘From Theory to Practice: Making Entrustable Professional Activities Come to Life in the Context of Milestones’, Academic Medicine, 89(10), p. 1321.

Frank, J. R., Snell, L. and Sherbino, J. (2014) ‘The draft CanMEDS 2015 physician competency framework–series IV’, Ottawa: The Royal College of Physicians and Surgeons of Canada.

Touchie, C. and Boucher, A. (2016) ‘Entrustable professional activities for the transition from medical school to residency’, Ottawa, Ontario, Canada: Association of Faculties of Medicine of Canada.

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