2015-2016 – Debra Pugh | Medical Council of Canada
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2015-2016 - Debra Pugh

Defining Entrustable Professional Activities for Procedural Skills


Debra Pugh, MD, FRCPC


I. Ma
L. Stroud
R. B. Cavalcanti
D. Shanks
M. Mylopoulos
S. Halman



Graduates of many residency training programs are required to be proficient in performing a number of bedside procedures, however many trainees do not master these skills during residency and report feeling ill-prepared to perform procedures. In part, this may be related to the fact that training programs provide limited formal assessment of procedural skills. Even when procedural ability is assessed, the focus tends to be on technical ability without encompassing other skills required in performing procedures, such as communication and problem solving. This may reflect a gap in the conceptualization of the competencies to be included in procedural expertise. Entrustable Professional Activities (EPAs) have the potential to be used as a framework for the assessment of procedural competence.


As a necessary first step in demonstrating evidence for the use of EPAs in the assessment of procedures, this study aims to (1) define procedural competence for the seven bedside procedures expected of graduates of Canadian Internal Medicine (IM) programs using EPAs as a framework, and (2) develop an EPA-based assessment tool for procedural skills.


Procedural EPA development will be divided into three phases. In Phase 1 of the study, EPA components for each procedure will be defined using the nominal group technique with focus groups of local subject matter experts. In Phase 2, surveys will be distributed to representatives from all Canadian IM training programs. Using a modified Delphi exercise, expert consensus will be sought about the importance of each EPA component. Qualitative survey comments will be analyzed using a framework approach and will inform a final EPA rubric for each procedure. Phase 3 will involve the development of a rubric for the assessment of procedural skills based on the EPAs.


Once developed, procedural EPAs will provide a robust foundation for future studies to address implementation and evaluation of an EPA-based assessment program.