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Milestones and Entrustable Professional Activities are important components of a competency-based approach to training and assessment. The following analysis of milestones and EPA's is based on the following 2 articles:

1. Hicks PJ, Englander R, Schumacher DJ, Burke A, Benson BJ, Guralnick S, Ludwig S, Carraccio C. Pediatrics Milestone Project: Next Steps Toward Meaningful Outcomes Assessment. J Grad Med Educ. 2010: 577-584.

2. Mulder H, Ten Cate O, Daalder R, Berkvens J. Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training. Med Teacher. 2010; 32: e453-e459.

Pediatric Milestone documents have the following structure:

  • Competency
    • Subcompetency
      • Background (narrative)
      • Developmental Milestones/Anchors (inherent notion of levels)
        • Elements (ex. truthfulness is an element of trustworthiness) - most elements are observable behaviours
        • Typical time range for achievement
      • References

According to Mulder et al, EPAs have the following structure:

  • Discipline (broader category)
  • Title
  • Description
  • Frequency
  • Domains of Competency (canmeds competencies)
  • Knowledge and skills required (list)
  • Assessment procedure (intentionally out of scope)

EPAs require certain competencies, specific knowlege, or skills. In the pediatrics model, specific anchors may determine when a person is "entrustable" for that activity. In Mulder's model, there are levels indicating decreasing levels of supervision when implemented in the curriculum. An activity is entrustable when a specific level of competence is attained.

EPAs may be implemented in a curriculum as a "schedule" of activities.

Mulder et al recommend "Statements of Awarded responsibility" (STAR) to indicate EPA mastery.

Clinical observation, performance, and performance over time are critical to the assessment of EPAs.

Most of the components of milestones and EPAs can be described in the current Competency Object  and Competency Framework structure. Exceptions are noted in Orange. In addition, the relationship that an EPA requires a competency is not something currently captured in the competency framework.

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1 Comment

  1. In terms of "requirement" - and its converse, optionality - I've set out some thinking at
    (which builds on other posts in the same series)
    I hope that is helpful.