Gersten Jonker

14   Chapter 1 The role of entrustable professional activities CBME can be strongly anchored in clinical work with entrustable professional activities [43, 44]. Entrustable professional activities (EPAs) relocate competencies from theory to clinical practice [45, 46]. An EPA is defined as an essential task of a discipline (profession, specialty, or subspecialty) that an individual can be trusted to performwithout direct supervision in a given health care context, once sufficient competence has been demonstrated [43, 44, 47]. An EPA can be executed as a discrete, observable and assessable entity in the workplace. EPAs display the training opportunities in clinical practice and direct the attention of assessing supervisors [43]. An EPA requires competencies from different competency domains and observing EPA performance allows inferences to be made about these competencies [43, 44, 48]. A set of EPAs clarify the learning objectives of a program [43] and thus what a program graduate is expected to be able to do; i.e. in postgraduate training a set of EPAs describes what a medical specialist can be expected to do. Learners develop their competence gradually toward the level of a medical specialist. Supervisors can entrust an EPA to a learner to execute that task without direct supervision, once the learner attained an adequate level of performance in the EPA [43, 44, 48]. This constitutes a formal summative decision, a certificate to execute a part of the work of the specialty. The granting of responsibility, through entrustment, requires an assessment system consisting of several tools to construe a robust viewon the trainees level of performance. In addition, entrustment is dependent on the degree of trust the supervisor has in the trainee, the trustworthiness of the trainee, the relationship that the supervisor and trainee have, task factors, and contextual factors [44, 45, 49-51]. During the development toward medical specialist, trainees attain competence, grow trust, and get progressive responsibility when increasing numbers of EPAs of increasing complexity are entrusted to them. This process may commence prior to entering residency and this puts CBME with EPAs in the position to improve the connection between stages and forge a continuum [3, 36].