Gersten Jonker

An agenda for development and research   159 8 Competency domains and EPAs can be seen as two dimensions of a grid, the competencies-activities matrix (Table 1) [18, 20]. By observing performance of an EPA, one implicitly observes several domains of competence [20]. Typically, for each EPA, multiple domains of competence are explicitly relevant, whereas other domains of competence weigh more heavily for other EPAs. If a resident is unable to perform an EPA, deficits in competencies that underpin this activity can be found and used for feedback and further learning [16, 21, 22]. TABLE 1: The competencies-activities matrix CanMEDS roles of competence Medical Expert Communicator Collaborator Manager Health Advocate Scholar Professional Entrustable Professional Activity 1 • • • Entrustable Professional Activity 2 • • • • Entrustable Professional Activity 3 • • • Entrustable Professional Activity 4 • • • • Entrustable Professional Activity 5 • • • • There may be both intra-individual and inter-individual differences in learning curves for EPAs, and residents may vary in the sequence in which they master them (Figure 1) [20]. In a developmental trajectory, junior residents will master simple EPAs whilst only more advanced trainees will master complex EPAs. EPAs clarify the level of proficiency by indicating the resident’s responsibilities and the necessary level of supervision. For any EPA, five levels of proficiency canbe distinguished, which translate into the levels of supervision to be provided (Table 2) [18, 20, 25, 26]. This level of proficiency should be recorded in the resident’s portfolio.