Introducing Entrustable Professional Activities (EPAs)

Entrustable Professional Activities (EPAs) are clearly defined units of professional practice that a trainee can progressively be trusted to perform with an appropriate level of supervision.

In pain medicine, EPAs represent authentic clinical responsibilities that bring together clinical knowledge, practical skills, communication, professional judgement, cultural safety, teamwork and patient-centred care. They can be observed in the workplace, supported through supervision and feedback, and assessed over time across a range of patients, settings and levels of complexity.

EPAs provide an organising framework that connects several elements of training and assessment:

• Competencies describe the knowledge, skills,behavioursand professional attributesrequiredfor effective specialist practice.

• Workplace-based feedback (WBF) forms collect evidence about a trainee’s performance in clinical practice.
• Observation guides and checklists help supervisors focus on relevant aspects of performance and record their observations consistently.

EPAs bring this evidence together around a complete professional activity and support a judgement about the trainee’s readiness for greater autonomy.

Entrustment decisions are specific to the activity, the clinical context and the available evidence. As trainees demonstrate consistent performance across increasingly complex situations, they can progress from close supervision towards greater autonomy and independent specialist practice.

Entrustable Professional Activities (EPAs) are being introduced to provide a clearer and more authentic way of supporting trainees’ progression towards independent specialist practice. This educational reform will better align to the graduate outcomes of the program. Importantly, it also makes explicit, decisions that already being made implicitly i.e. do I trust this trainee to undertake this aspect of professional practice and, with what level of supervision?

EPAs provide a coherent framework for gathering and connecting evidence from across the training program. Drawing on multiple observations, settings and assessment methods will allow trainee progress to be considered over time, rather than relying too heavily on any single examination or assessment event.

The introduction of EPAs forms part of the FPM's longer-term review of its assessment framework.

Recent reforms include:

• Scholar role activities (substituting for the clinical case study).
• Foundations-level multiple-choice question (MCQ) examination (substituting for the single answer question (SAQ) examination.
• Retirement of the long case assessment.

These changes have occurred in response to feedback from trainees and Supervisors of Training and an acknowledgment that assessments should sample the curriculum more broadly and reflect the realities of contemporary clinical practice.

The decision to introduce EPAs draws on contemporary practice in specialist medical education, the emerging evidence base and the expectations of our regulators. It also represents a further step towards a fuller model of programmatic assessment, in which evidence from different parts of the program is deliberately triangulated to build a more complete and defensible picture of each trainee’s development.

Feedback from trainees and supervisors of training (SOTs) will continue to inform how EPAs are introduced and embedded. Supervisors will be supported to provide high-quality narrative feedback in a timely manner, giving trainees specific and actionable guidance about their progress and the next steps in their development. Our aim is to provide a system of assessment that is better connected, more educationally useful and more closely aligned with the capabilities expected of an FPM graduate.

EPA assessment draws on a body of workplace-based evidence gathered over time. A single clinical encounter provides one useful data point; an entrustment decision is based on a broader pattern of performance across different patients, settings, levels of complexity and supervisors.

The aim is to build a portfolio of descriptive evidence, entered into the ePortfolio, that demonstrates a trainee’s development, responsiveness to feedback and readiness for increasing autonomy. 

Evidence may include:

• Direct observation of clinical practice;
• Case-based discussions;
• Reviews of clinical documentation;
• Multi-source feedback;
• Deidentified patient feedback, where appropriate;
• Trainee reflection arising from the workplace-based feedback activities;
• Learning goals and action plans; and
• Relevant assessment evidence aggregated within the ePortfolio.

The value of the evidence depends on its quality, range and context, as well as its quantity. Supervisors will consider factors such as the complexity and risk of the activity, the consistency of the trainee’s performance, the level of support required, the trainee’s clinical reasoning and communication, and how effectively they respond to feedback.

Evidence collection should remain brief, practical and embedded in routine clinical work. Supervisors will record concise narrative feedback that identifies strengths, areas for development, the degree of supervision required and clear next steps. Trainees will use this feedback to reflect on their performance, set goals and demonstrate progress in subsequent encounters.

Supervisors and fellows will play a central role in the success of EPA implementation. A suite of online modular learning resources and webinars has been designed to strengthen the professional judgements supervisors already make about trainee readiness to practice independently, patient risk and the level of supervision required.

Self-directed online modules will establish a common foundation for understanding best practice around EPAs. Small-group webinars will then allow supervisors to apply the concepts to realistic cases, compare supervision judgements, review sufficient and insufficient evidence, practise feedback, discuss “not yet entrusted” decisions and address local implementation questions.

In preparation for EPA implementation, supervisors and fellows will be supported through online learning and facilitated webinars to:

• Distinguish EPAs from competencies, checklists and workplace-based feedback;
• Apply agreed supervision levels to real clinical work, taking account of context, complexity and risk;
• Use workplace-based feedback tools, documentation reviews and other observations as evidence for EPA decisions;
• Judge whether the available evidence is sufficiently recent, relevant and varied to support an entrustment decision;
• Write brief narrative feedback that explains the supervision judgement and identifies a useful next step for the trainee;
• Recognise how Agency, Reliability, Integrity, Capability and Humility contribute to trust;
• Identify and reduce bias or inconsistent risk thresholds in assessment decisions;
• Support trainees to reflect, set learning goals and curate evidence across more than one context, where feasible;
• Use ePortfolio to record, review and aggregate EPA evidence; and
• Respond constructively when a trainee is "not yet entrusted", including developing remediation learning plans with appropriate review points.

EPAs are designed to help understand how workplace learning, feedback and progression decisions fit together. Through the FPM training program trainees are supported to see how repeated evidence, gathered over time and across different clinical contexts, contributes to judgements about readiness for increasing independence.

Through dedicated trainee learning materials, trainees will learn what EPAs are, how they differ from competencies and WBFs, and how EPA evidence is used to inform supervision and progression decisions. Training material will explain how work-place based feedback, observed consultations, documentation reviews, reflection and other evidence contributes to EPA evidence. 

Trainees will learn how to take an active role in their development, including how to seek useful feedback, respond to feedback constructively, identify gaps in evidence, set learning goals with their supervisor, and curate evidence in their ePortfolio. The aim is to assist trainees understand not only what evidence is required, but why it matters and how it demonstrates developing capability over time.

The trainee resources explain how supervision levels work, why context and risk matter, and why a trainee may be ready for greater independence in one setting while still needing closer supervision in another. This will support trainees to have clearer conversations with their supervisor about what they can do safely, what still requires supervision, and what further practice or evidence is needed.

A suite of online resources provides the core foundation, supported by ePortfolio guidance, evidence-curation examples, reflection prompts and FAQs ,. Together, these resources will help trainees prepare for EPA-based assessment, understand expectations, and use feedback as part of a longitudinal learning process. 

Resources for trainees

A range of resources will support trainees to understand EPAs, gather and review evidence, and use feedback to guide their development. 

These include:

Trainee guidance 
An introduction to EPAs, how they operate within training, and how EPA evidence informs supervision and progression decisions.

Online learning 
Core concepts including EPAs, supervision levels, workplace evidence, feedback, reflection and the trainee’s active role in learning.

Evidence-curation examples 
Practical examples showing how different forms of evidence can be gathered and organised over time to demonstrate developing capability across an EPA.

MyPortfolio guidance 
Information on recording, tagging and reviewing EPA evidence, identifying gaps and preparing for discussions with the SOT.

SOT–trainee orientation checklistt 
A framework for clarifying expectations, including how evidence and feedback will be gathered, reviewed and used to guide learning.

Reflection and goal-setting promptst 
Tools to help trainees interpret feedback, identify next steps, set learning goals and monitor their progress across different clinical contexts.