True Entrustment Decisions Regarding Entrustable Professional Activities Happen in the Workplace, not in the Classroom Setting

Entrustable Professional Activities (EPAs) are workplace responsibilities that directly impact patient care. The use of EPAs allows learners to be provided with feedback and assessment in the clinical setting. Because they focus assessment on the execution of professional activities with all integrated competencies needed, EPAs help provide a more holistic picture of student performance. Using the EPAs to backwards design classroom learning on those competencies is highly encouraged, but one cannot or should not assess performance and make entrustment decisions using EPAs in the classroom setting for several reasons: classroom performance usually does not predict clinical performance very well, EPAs require direct observations, EPA assessment requires multiple observations of varying patients with varying level of acuity and most importantly, EPA-focused assessment must result in entrustment decisions to perform with limited supervision. By ensuring all entrustment decisions are made in a clinical or experimental setting, students will receive an accurate assessment and benchmark of their performance to lead them one step closer to independent practitioners.