H. Carrie Chen, MD, PhD, Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) Associate Dean for Medical Education Research and Scholarship, has co-authored and co-edited a groundbreaking new book that dives deep into the shift toward ensuring that graduates provide safe, quality patient care through entrustable professional activities (EPAs).
Published in October 2024, Entrustable Professional Activities and Entrustment Decision-Making in Health Professions Education was developed to help educators understand and incorporate EPAs into their programs. Dr. Chen served as one of the book’s five main editors and co-authors alongside fellow experts Olle tan Cate, Vanessa C. Birch, Fremen Chihchen Chou, and Marije P. Hennus. A group of international authors also contributed to the book, sharing their experiences implementing EPAs in various fields of health education.
“I am most excited and proud of the fact that all of the editors and several of the authors contributed their honoraria from teaching in a course about EPAs to pay the publishing fees so that an electronic version of the book could be offered open access and made available to everyone, including those in low resource contexts,” said Dr. Chen. “It was a tremendous experience and privilege to work with and learn from a large international group in putting this book together. Many of us met each other for the first time while working on the book and only met each other in person at a final book completion celebration in late August.”
The authors collaborated to share how useful the EPA framework can be for both undergraduate and postgraduate education in medicine as well as other health professions, covering important topics like theory, curriculum planning, workplace assessments, faculty development, and how to put EPAs into practice. The book also provides many valuable resources to support educators and program designers.
In the following interview, lightly edited for clarity and length, Dr. Chen discusses her work on EPAs.
How would you describe EPAs, and why are they important?
EPAs are an approach to defining educational or training outcomes that articulate what it is that the public should be able to entrust someone at the end of their training to be able to do. For instance, one should be able to entrust an obstetrician to deliver a baby. It frames the outcomes around key patient care activities and brings in the concept of trust. For trust to be awarded, trainees must not only demonstrate knowledge, skills, and situational awareness, they must be reliable, demonstrate integrity and patient-centeredness, be able and willing to recognize their limits and ask for help, and be proactive in patient care and their own development. Operationalized as part of competency-based education, EPAs can ensure that all trainees graduate only when they can be entrusted to perform the activities defined for their profession, thus improving the quality and safety of patient care.
EPAs have been in practice to some degree for about 20 years now. How has the concept developed over that time?
The concept was introduced about 20 years ago, and it took a little time for the community to think through how to operationalize the concept. I would say the core concept remains the same, but the community is gaining a more nuanced understanding of how supervision and entrustment decisions are made; how curricula built around EPAs might be different for UME, GME, other professions, and different countries; how existing assessments might need to be adjusted to capture information on trust; and what faculty and trainees struggle with in implementation, etc. As people have worked to implement EPAs across a variety of contexts, the community is learning a lot about best practices and pitfalls, which is part of the impetus for the book. It tries to summarize what we know so far, explaining the principles behind the EPA concept, but also sharing practical information on what we know so far about implementation.
How are EPAs being implemented or applied at KPSOM?
While some schools or programs might rely solely on EPAs to define their outcomes, KPSOM defines our graduation outcomes based on both the Physician Competency Reference Set and the Core EPAs from the AAMC. This means that EPAs are embedded in our outcomes, how the curriculum and clinical experiences are designed, and included as an element in our assessments.
What was it like to collaborate with international experts to create this book?
It was tremendous fun and a wonderful learning experience. While we had all read each other’s work, it was the first time many of us worked together and had the opportunity to really get to know each other, dig into our assumptions, and consider what can be learned from experiences with EPAs across contexts – UME, GME, various professions, and different countries. Many new friendships and professional collaborations were forged.
What are your goals for this book?
We, the editors, plan to use the book in our course on EPAs and in our faculty development work. Our hope is that it can be used by everyone interested in EPAs, particularly those in low resource environments, to advance their own understanding and work on EPAs – whether for practical implementation in their individual settings or for their scholarship and research.
Entrustable professional activities and entrustment decision-making in health professions education is available as a free e-book for download (entire book or individual chapters) from the publisher’s website. Hardcopy books are available on Amazon.
