Core Entrustable Professional

Activities for Entering Residency

EPA 3 Toolkit: Recommend and Interpret Common
Diagnostic and Screening Tests

Learn
Serve
Lead

Association of
American Medical Colleges
EPA 3 Toolkit: Recommend and Interpret Common Diagnostic and Screening Tests

Association of American Medical Colleges

Washington, D.C.
EPA 3 Workgroup
Diane Biskobing, MD, Virginia Commonwealth University
Linda Chang, PharmD, MPH, University of Illinois
Angela Thompson-Busch, MD, PhD, Michigan State University

Senior Editors
Vivian Obeso, MD, Florida International University
David Brown, MD, Florida International University
Carrie Phillipi, MD, PhD, Oregon Health & Science University

Editors
Meenakshy Aiyer, MD, University of Illinois
Beth Barron, MD, Columbia University
Jan Bull, MA, Association of American Medical Colleges
Teresa J. Carter, EdD, Virginia Commonwealth University
Matthew Emery, MD, MSc, Michigan State University
Colleen Gillespie, PhD, New York University
Mark Hormann, MD, The University of Texas Health Science Center at Houston
Abbas Hyderi, MD, MPH, University of Illinois
Carla Lupi, MD, Florida International University
Michael L. Schwartz, PhD, Yale University
Margaret Uthman, MD, The University of Texas Health Science Center at Houston
Eduard E. Vasilevskis, MD, MPH, Vanderbilt University
Sandra Yingling, PhD, University of Illinois

AAMC Staff
Alison Whelan, MD Chris Hanley, MBA Lynn Shaull, MA
Chief Medical Education Officer Project Manager Senior Research Specialist

For inquiries and correspondence, contact Dr. Vivian Obeso at vobeso@fiu.edu, Carrie Phillipi at phillica@ohsu.edu, or Dr. Alison Whelan
at awhelan@aamc.org.

This is a publication of the Association of American Medical Colleges. The AAMC serves and leads the academic medicine community to
improve the health of all. aamc.org

© 2017 Association of American Medical Colleges. May be reproduced and distributed with attribution for educational or
noncommercial purposes only.

Suggested Toolkit Citation:

Obeso V, Brown D, Aiyer M, Barron B, Bull J, Carter T, Emery M, Gillespie C, Hormann M, Hyderi A, Lupi C, Schwartz M, Uthman M,
Vasilevskis EE, Yingling S, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program. Toolkits for the 13 Core Entrustable
Professional Activities for Entering Residency. Washington, DC: Association of American Medical Colleges; 2017.
aamc.org/initiatives/coreepas/publicationsandpresentations.

Suggested One-Page Schematic Citation:

Biskobing D, Chang L, Thompson-Busch A. Core Entrustable Professional Activities for Entering Residency—EPA 3 Schematic: Recommend
and Interpret Common Diagnostic and Screening Tests. Obeso V, Brown D, Phillipi C, eds. Washington, DC: Association of American
Medical Colleges; 2017. aamc.org/initiatives/coreepas/publicationsandpresentations.
 Contents
User Guide .................................................................................................................................................... 2
One-Page Schematics.................................................................................................................................... 3
Frequently Asked Questions ......................................................................................................................... 5
EPA 3 Schematic ............................................................................................................................................ 7
Appendix 1: Core EPA Pilot Supervision and Coactivity Scales .................................................................... .8
Appendix 2: Resources Related to EPA 3 .................................................................................................... 10
Appendix 3: Behaviors and Vignettes ......................................................................................................... 11
Appendix 4: The Physician Competency Reference Set (PCRS) .................................................................. 12
References .................................................................................................................................................. 16
Publications From the Core EPA Pilot ..................................................................................................... 16
Other Related Publications ..................................................................................................................... 16

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 User Guide
This toolkit is for medical schools interested in implementing the Core Entrustable Professional Activities (EPAs) for Entering
Residency. Written by the AAMC Core EPA Pilot Group, the toolkit expands on the EPA framework outlined in the EPA
Developer’s Guide (AAMC 2014). The Pilot Group identified progressive sequences of student behavior that medical
educators may encounter as students engage in the medical school curriculum and became proficient in integrating their
clinical skills. These sequences of behavior are articulated for each of the 13 EPAs in one-page schematics to provide a
framework for understanding EPAs; additional resources follow.
This toolkit includes:
 One-page schematic of each EPA
 Core EPA Pilot supervision and coactivity scales
 List of resources associated with each EPA
 Reference to EPA bulleted behaviors and vignettes from the Core EPA Guide
 The Physician Competency Reference Set
 Opportunities for engagement with the Core EPA Pilot

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 One-Page Schematics
In 2014, the AAMC launched a pilot project with 10 institutions to address the feasibility of implementing 13 EPAs for
entering residency in undergraduate medical education. To standardize our approach as a pilot and promote a shared
mental model, the Core EPA Pilot Group developed one-page schematics for each of the 13 EPAs.

These schematics were developed to translate the rich and detailed content within The Core Entrustable Professional
Activities for Entering Residency Curriculum Developers’ Guide published in 2014 by the AAMC into a one-page, easy-to-use
format (AAMC 2014). These one-page schematics of developmental progression to entrustment provide user-friendly
descriptions of each EPA. We sought fidelity to the original ideas and concepts created by the expert drafting panel that
developed the Core EPA Guide.

We envision the one-page schematics as a resource for:

 Development of curriculum and assessment tools

 Faculty development
 Student understanding
 Entrustment committees, portfolio advisors, and others tracking longitudinal student progress

Understanding the One-Page Schematic

Performance of an EPA requires integration of multiple competencies (Englander and Carraccio 2014). Each EPA schematic
begins with its list of key functions and related competencies. The functions are followed by observable behaviors of
increasing ability describing a medical student’s development toward readiness for indirect supervision. The column
following the functions lists those behaviors requiring immediate correction or remediation. The last column lists expected
behaviors of an entrustable learner.

The members of the Curriculum and Assessment Team of the Core EPA Pilot Group led this initiative. Thirteen EPA groups,
each comprising representatives from four to five institutions, were tasked with creating each EPA schematic. Development
of the schematics involved an explicit, standardized process to reduce variation and ensure consistency with functions,
competencies, and the behaviors explicit in the Core EPA Guide. Behaviors listed were carefully gathered from the Core EPA
Guide and reorganized by function and competency and listed in a developmental progression. The Curriculum and
Assessment Team promoted content validity by carrying out iterative reviews by telephone conference call with the
members of the Core EPA Pilot Group assigned to each EPA.

EPA Curriculum and Assessment

Multiple methods of teaching and assessing EPAs throughout the curriculum will be required to make a summative
entrustment decision about residency readiness. The schematics can help to systematically identify and map curricular
elements required to prepare students to perform EPAs. Specific prerequisite curricula may be needed to develop
knowledge, skills, and attitudes before the learner engages in practice of the EPA.

To implement EPAs, medical schools should identify where in the curriculum EPAs will be taught, practiced, and assessed.
Among other modalities, simulation, reflection, and standardized and structured experiences will all provide data about
student competence. However, central to the concept of entrustment is the global performance of EPAs in authentic clinical
settings, where the EPA is taught and assessed holistically, not as the sum of its parts.

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 Workplace-Based Assessments: Supervision and Coactivity Scales
On a day-to-day basis, clinical supervisors make and communicate judgments about how much help (coactivity) or
supervision a student or resident needs. “Will I let the student go in the room without me? How much will I let the student
do versus observe? Because I wasn’t present to observe, how much do I need to double-check?” Scales for clinical
supervisors to determine how much help or supervision a student needs for a specific activity have been proposed (Chen et
al 2015; Rekman et al 2016). There is limited validity evidence for these scales, and no published data comparing them.
Given our initial experience, the Core EPA Pilot Group has agreed on a trial using modified versions of these scales (Appendix
1).

Resources
The Pilot Group compiled a list of resources, including relevant Critical Synthesis Packages from MedEdPORTAL®, a review of
current existing literature, teaching methods, and assessment tools related to each EPA (Appendix 2). This collection of
products may help schools with implementation. For example, schools may find the teaching methods and assessment tools
useful when considering multiple sources of data about student performance that may eventually contribute to a summative
entrustment decision. The Pilot Group concluded that new teaching methods and assessment tools will be needed to
complement these resources. This need is particularly relevant for workplace-based assessments where the synthetic
performance of an EPA is linked to a level of supervision. We envision the one-page schematics as a resource for the
development of new teaching and assessment methods.

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 Frequently Asked Questions

Why are EPAs important?

In many cases, medical school graduates are perceived by residency program directors as insufficiently prepared at the
beginning of their residency training for indirect supervision in clinical skills and for exhibiting professional behaviors. The
EPAs define a shared set of clinical activities that residents are expected to perform on day one of residency. This is an
important opportunity for undergraduate medical education to develop a new construct toward preparedness and, as an
end goal, improvements in patient safety. Ideally, students will perform the Core EPAs consistently in situations of varying
complexity as they practice and receive actionable feedback, formulating learning goals for future demonstrations of
competence.

What does “entrustment” mean in the context of the EPAs?

Entrustment is defined as trustworthiness in applying knowledge, skills, and attitudes in performance of an EPA. To be
“trustworthy,” students must consistently demonstrate attributes such as conscientiousness, knowledge of their own limits
and help-seeking behavior (discernment), and truthfulness (Kennedy et al 2008). Throughout medical education, students
should be assessed on trustworthiness—though this may occur implicitly or explicitly. The EPA framework makes this
assessment explicit and transparent.

EPA entrustment is defined as a judgment by a supervisor or collection of supervisors signaling a student has met specific,
defined expectations for needing limited supervision. The Core EPA Pilot Group recommends the formation of an
entrustment committee to make evidence-based summative entrustment decisions about each student’s readiness for
residency (Brown et al 2017).

What is the relationship between competencies and EPAs?

The EPA framework reorganizes competencies into observable units of clinical work by function. Each function is a subunit of
work required to perform an EPA. The functions and related competencies are the parts, and the EPA is the whole. The
Toolkit’s one-page schematics highlight an EPA’s specific functions with underlying competencies into observable behaviors
within a developmental progression toward entrustment.
Although tracking progression within individual functions can help learners develop appropriate skills, monitoring learner
progress toward entrustability for that EPA requires synthesis: At some point the learner must apply each of the functions in
execution of the EPA task. To this end, we emphasize the importance of the holistic nature of the EPA and prioritize
assessment for entrustment in these activities in workplace settings as a whole, not as the sum of their parts.

Is the one-page schematic designed as a rubric for student assessment?

No, the one-page schematics are not intended to serve as assessment tools. They can serve as guides for development of
instructional, feedback, and assessment tools for EPAs. We share them as a framework for understanding the
developmental progression that graduating medical students should demonstrate as a reflection of their readiness for
residency.

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 How can I or my institution become more involved?
Medical schools in the AAMC pilot, those interested in implementing EPAs, and those wondering about the faculty resources
needed to teach and assess EPAs are already part of a dynamic learning community. Opportunities for engaging with others
exist through the AAMC Core EPA listserve, conference presentations, collaborative projects, and in informal medical
education networks. Your contributions help shape the work of the Core EPA Pilot project and are a source of new ideas,
feedback, and suggestions for implementation. We invite you to continue your conversations with us by sharing the
decisions you face within the unique culture of your institution.

 To subscribe to the Core EPAs listserve, send a blank email to subscribe-coreepas@lists.aamc.org. To post a
comment to the listserve, simply send an email to coreepas@lists.aamc.org.

 Core EPA Pilot Website: https://www.aamc.org/initiatives/coreepas/

 Publications from the Core EPA Pilot Group:

https://www.aamc.org/initiatives/coreepas/publicationsandpresentations/

 Core EPA Pilot Group email for queries and observations: coreepas@aamc.org

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EPA 3: Recommend and Interpret Common Diagnostic and Screening Tests
Key Functions with Behaviors
An EPA: A unit of Related Competencies Requiring
observable, measurable Corrective
professional practice Recommend first-line  Developing Behaviors  Expected Behaviors for an
requiring integration of cost-effective screening Response (Learner may be at different levels within a row.) Entrustable Learner
competencies and diagnostic tests for Unable to recommend Recommends tests for Considers costs Recommends key, reliable, cost-
routine health a standard set of common conditions effective screening and diagnostic
maintenance and screening or diagnostic Identifies guidelines for tests
common disorders tests Does not consider harm, standard tests
costs, guidelines, or Applies patient-specific guidelines
Demonstrates
EPA 3 PC5 PC9 SBP3 PBLI9
KP1 KP4
frustration at cost-
patient resources Repeats diagnostic tests
at intervals that are too
containment efforts Does not consider frequent or too lengthy
patient-specific
screening unless
Diagnostic instructed
and Provide rationale for
screening Recommends Understands pre- and Provides individual rationale based
decision to order tests, unnecessary tests or posttest probability on patient’s preferences,
Cannot provide a
tests taking into account pre- tests with low pretest demographics, and risk factors
rationale for ordering
and posttest probability tests probability Neglects impact of false
and patient preference positive or negative results Incorporates sensitivity, specificity,
Neglects patient’s and prevalence in recommending
preferences Aware of patient’s and interpreting tests
PC5 PC7 KP1 KP4
preferences
SBP3 PBLI9 Explains how results will influence
Underlying diagnosis and evaluation
entrustability for all
EPAs are trustworthy
habits, including
truthfulness,
conscientiousness, Can only interpret Misinterprets Recognizes need for Distinguishes common, insignificant
and discernment. results based on insignificant or assistance to evaluate abnormalities from clinically
normal values from the explainable urgency of results and important findings
Interpret results of basic lab abnormalities communicate these to
This schematic depicts development
studies and understand patient Discerns urgent from nonurgent
of proficiency in the Core EPAs. It is the implication and Does not discern Does not know how to results and responds correctly
not intended for use as an urgency of the results urgent from nonurgent respond to urgent test
assessment instrument. Entrustment results results Seeks help for interpretation of tests
decisions should be made after EPAs PC4 PC5 PC7 KP1 beyond scope of knowledge
have been observed in multiple Requires supervisor to
settings with varying context, acuity, discuss results with
and complexity and with varying patient
patient characteristics.

Biskobing, D, Chang, L, Thompson-Busch, A. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 7
 Appendix 1: Core EPA Pilot Supervision and Coactivity Scales
Scales for clinical supervisors to determine how much help (coactivity) or supervision they judge a student needs for a
specific activity have been proposed—the Chen entrustment scale and the Ottawa scale (Chen et al 2015; Rekman et al
2016). There is limited validity evidence for these scales and no published data comparing them. We include these published
tools here for your reference. The Core EPA Pilot Group has agreed on a trial using modified versions of these scales
(described below). A description of how the pilot is working with these scales is available on the Core EPA website.

Modified Chen entrustment scale: If you were to Corresponding excerpt from original Chen entrustment scale (Chen et al
supervise this student again in a similar situation, which of 2015)
the following statements aligns with how you would assign
the task?

1b. “Watch me do this.” 1b. Not allowed to practice EPA; allowed to observe

2a. “Let's do this together.” 2a. Allowed to practice EPA only under proactive, full supervision as
coactivity with supervisor

2b. “I'll watch you.” 2b. Allowed to practice EPA only under proactive, full supervision
with supervisor in room ready to step in as needed
3a. “You go ahead, and I'll double-check all of your 3a. Allowed to practice EPA only under reactive/on-demand
findings.” supervision with supervisor immediately available, all findings
double-checked
3b. “You go ahead, and I'll double-check key 3b. Allowed to practice EPA only under reactive/on demand
findings.” supervision with supervisor immediately available, key findings
double-checked

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 Modified Ottawa scale: In supervising this student, how Original Ottawa scale (Rekman et al 2016)
much did you participate in the task?

1. “I did it.” Student required complete guidance or was 1. “I had to do.” (i.e., requires complete hands-on guidance, did not do,
unprepared; I had to do most of the work myself. or was not given the opportunity to do)

2. “I talked them through it.” Student was able to 2. “I had to talk them through.” (i.e., able to perform tasks but requires
perform some tasks but required repeated directions. constant direction)

3. “I directed them from time to time.” Student 3. “I had to prompt them from time to time.” (i.e., demonstrates some
demonstrated some independence and only required independence, but requires intermittent direction)
intermittent prompting.

4. “I was available just in case.” Student functioned 4. “I needed to be there in the room just in case.” (i.e., independence but
fairly independently and only needed assistance with unaware of risks and still requires supervision for safe practice)
nuances or complex situations.

5. (No level 5: Students are ineligible for complete 5. “I did not need to be there.” (i.e., complete independence, understands
independence in our systems.) risks and performs safely, practice ready)

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 Appendix 2: Resources Related to EPA 3

Hypothesis-Driven Physical Examination (HDPE)

Uchida T, Heiman H. Critical synthesis package: hypothesis-driven physical examination (HDPE). MedEdPORTAL Publications.
2013;9:9435. doi.org/10.15766/mep_2374-8265.9435.

Script Concordance Testing (SCT)

Russell J. Critical synthesis package: script concordance testing (SCT). MedEdPORTAL Publications. 2013;9:9492.
doi.org/10.15766/mep_2374-8265.9492.

Professionalism Mini-Evaluation Exercise (P-MEX)

Gathright M. Critical synthesis package: professionalism mini-evaluation exercise (P-MEX). MedEdPORTAL Publications.
2014;10:9929. doi.org/10.15766/mep_2374-8265.9929.

Shared Decision-Making (SDM) Toolkit: Train the Trainer

Mincer S, Adeogba S, Bransford R, et al. Shared decision-making (SDM) toolkit: train-the-trainer tools for teaching SDM in
the classroom and clinic. MedEdPORTAL Publications. 2013;9:9413. doi.org/10.15766/mep_2374-8265.9413.

Evidence and Instruments in the Literature

Decision Boxes (Link)

Giguere AMC, Labrecque M, Légaré F, et al. Feasibility of a randomized controlled trial to evaluate the impact of decision
boxes on shared decision-making processes. BMC Med Inform Decis Mak. 2015;15. doi: 10.1186/s12911-015-0134-x.

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 Appendix 3: Behaviors and Vignettes

The Core EPA Guide produced by the AAMC contains additional detailed information that may be useful for curriculum
designers.

1. For a convenient list of behaviors for this EPA that were used to develop a developmental progression, we refer you
to the Core EPA Guide.

2. For exemplars of learner vignettes that highlight pre-entrustable and entrustable scenarios, please see the Core EPA
Guide.

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 Appendix 4: The Physician Competency Reference Set (PCRS)

The Physician Competency Reference Set (Englander et al 2013) is provided for cross-referencing with the one-page
schematic.

1. PATIENT CARE (PC): Provide patient-centered care that is compassionate, appropriate, and effective
for the treatment of health problems and the promotion of health
1.1 Perform all medical, diagnostic, and surgical procedures considered essential for the area of
practice
1.2 Gather essential and accurate information about patients and their condition through history-
taking, physical examination, and the use of laboratory data, imaging, and other tests
1.3 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient
1.4 Interpret laboratory data, imaging studies, and other tests required for the area of practice
1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment
1.6 Develop and carry out patient management plans
1.7 Counsel and educate patients and their families to empower them to participate in their care and
enable shared decision making
1.8 Provide appropriate referral of patients, including ensuring continuity of care throughout
transitions between providers or settings and following up on patient progress and outcomes
1.9 Provide health care services to patients, families, and communities aimed at preventing health
problems or maintaining health
1.10 Provide appropriate role modeling
1.11 Perform supervisory responsibilities commensurate with one’s roles, abilities, and qualifications
2. KNOWLEDGE FOR PRACTICE (KP): Demonstrate knowledge of established and evolving biomedical,
clinical, epidemiological, and social–behavioral sciences, as well as the application of this knowledge to
patient care
2.1 Demonstrate an investigatory and analytic approach to clinical situations
2.2 Apply established and emerging biophysical scientific principles fundamental to health care for
patients and populations
2.3 Apply established and emerging principles of clinical sciences to diagnostic and therapeutic
decision making, clinical problem solving, and other aspects of evidence-based health care
2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors,
treatment strategies, resources, and disease prevention/health promotion efforts for patients
and populations
2.5 Apply principles of social–behavioral sciences to provision of patient care, including assessment
of the impact of psychosocial–cultural influences on health, disease, care-seeking, care
compliance, and barriers to and attitudes toward care
2.6 Contribute to the creation, dissemination, application, and translation of new health care
knowledge and practices

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 3. PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI): Demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and lifelong learning
3.1 Identify strengths, deficiencies, and limits in one’s knowledge and expertise
3.2 Set learning and improvement goals
3.3 Identify and perform learning activities that address one’s gaps in knowledge, skills, or attitudes
3.4 Systematically analyze practice using quality-improvement methods, and implement changes
with the goal of practice improvement
3.5 Incorporate feedback into daily practice
3.6 Locate, appraise, and assimilate evidence from scientific studies related to patients’ health
problems
3.7 Use information technology to optimize learning
3.8 Participate in the education of patients, families, students, trainees, peers, and other health
professionals
3.9 Obtain and utilize information about individual patients, populations of patients, or communities
from which patients are drawn to improve care
3.10 Continually identify, analyze, and implement new knowledge, guidelines, standards,
technologies, products, or services that have been demonstrated to improve outcomes

4. INTERPERSONAL AND COMMUNICATION SKILLS (ICS): Demonstrate interpersonal and

communication skills that result in the effective exchange of information and collaboration with
patients, their families, and health professionals
4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad
range of socioeconomic and cultural backgrounds
4.2 Communicate effectively with colleagues within one’s profession or specialty, other health
professionals, and health-related agencies (see also interprofessional collaboration competency,
IPC 7.3)
4.3 Work effectively with others as a member or leader of a health care team or other professional
group (see also IPC 7.4)
4.4 Act in a consultative role to other health professionals
4.5 Maintain comprehensive, timely, and legible medical records
4.6 Demonstrate sensitivity, honesty, and compassion in difficult conversations (e.g., about issues
such as death, end-of-life issues, adverse events, bad news, disclosure of errors, and other
sensitive topics)
4.7 Demonstrate insight and understanding about emotions and human responses to emotions that
allow one to develop and manage interpersonal interactions
5. PROFESSIONALISM (P): Demonstrate a commitment to carrying out professional responsibilities and
an adherence to ethical principles
5.1 Demonstrate compassion, integrity, and respect for others
5.2 Demonstrate responsiveness to patient needs that supersedes self-interest
5.3 Demonstrate respect for patient privacy and autonomy

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 5.4 Demonstrate accountability to patients, society, and the profession
5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including but not
limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
5.6 Demonstrate a commitment to ethical principles pertaining to provision or withholding of care,
confidentiality, informed consent, and business practices, including compliance with relevant
laws, policies, and regulations
6. SYSTEMS-BASED PRACTICE (SBP): Demonstrate an awareness of and responsiveness to the larger
context and system of health care, as well as the ability to call effectively on other resources in the
system to provide optimal health care
6.1 Work effectively in various health care delivery settings and systems relevant to one’s clinical
specialty
6.2 Coordinate patient care within the health care system relevant to one’s clinical specialty
6.3 Incorporate considerations of cost awareness and risk–benefit analysis in patient and/or
population-based care
6.4 Advocate for quality patient care and optimal patient care systems
6.5 Participate in identifying system errors and implementing potential systems solutions
6.6 Perform administrative and practice management responsibilities commensurate with one’s role,
abilities, and qualifications
7. INTERPROFESSIONAL COLLABORATION (IPC): Demonstrate the ability to engage in an
interprofessional team in a manner that optimizes safe, effective patient- and population-centered
care
7.1 Work with other health professionals to establish and maintain a climate of mutual respect,
dignity, diversity, ethical integrity, and trust
7.2 Use the knowledge of one’s own role and those of other professions to appropriately assess and
address the health care needs of the patients and populations served
7.3 Communicate with other health professionals in a responsive and responsible manner that
supports the maintenance of health and the treatment of disease in individual patients and
populations
7.4 Participate in different team roles to establish, develop, and continuously enhance
interprofessional teams to provide patient- and population-centered care that is safe, timely,
efficient, effective, and equitable
8. PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD): Demonstrate the qualities required to sustain
lifelong personal and professional growth
8.1 Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to
engage in appropriate help-seeking behaviors
8.2 Demonstrate healthy coping mechanisms to respond to stress
8.3 Manage conflict between personal and professional responsibilities
8.4 Practice flexibility and maturity in adjusting to change with the capacity to alter behavior
8.5 Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the
care of patients
8.6 Provide leadership skills that enhance team functioning, the learning environment, and/or the
health care delivery system

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 8.7 Demonstrate self-confidence that puts patients, families, and members of the health care team
at ease
8.8 Recognize that ambiguity is part of clinical health care and respond by using appropriate
resources in dealing with uncertainty

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 References

Publications From the Core EPA Pilot Group

Brown DR, Gillespie CC, Warren JB. EPA 9—Collaborate as a member of an interprofessional team: a short communication
from the AAMC Core EPAs for Entering Residency Pilot Schools. Med Sci Educ. 2016;26(3):457-461.

Brown DR, Warren JB, Hyderi A, Drusin RE, Moeller J, Rosenfeld M, et al. Finding a path to entrustment in undergraduate
medical education: a progress report from the AAMC Core Entrustable Professional Activities for Entering Residency
Entrustment Concept Group. Acad Med. 2017;92(6):774-779.

Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains
for the health professions and competencies for physicians. Acad Med. 2013;88(8):1088-1094.

Englander R, Carraccio C. From theory to practice: making entrustable professional activities come to life in the context of
milestones. Acad Med. 2014;89(10):1321-1323.

Favreau MA, Tewksbury L, Lupi C, Cutrer WB, Jokela JA, Yarris LM. Constructing a shared mental model for faculty
development for the Core Entrustable Professional Activities for Entering Residency. Acad Med. 2017;92(6):759-764.

Lomis KD, Ryan MS, Amiel JM, Cocks PM, Uthman MO, Esposito KF. Core entrustable professional activities for entering
residency pilot group update: considerations for medical science educators. Med Sci Educ. 2016;26(4):797-800.

Lomis K, Amiel JM, Ryan MS, et al. Implementing an entrustable professional activities framework in undergraduate medical
education: early lessons from the AAMC core entrustable professional activities for entering residency pilot. Acad Med.
2017;92(6):765-770.

Other Related Publications

Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency.
mededportal.org/icollaborative/resource/887. May 28, 2014. Accessed March 1, 2016.

Chen HC, van den Broek WS, ten Cate O. The case for use of entrustable professional activities in undergraduate medical
education. Acad Med. 2015;90(4):431-436.

Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains
for the health professions and competencies for physicians. Acad Med. 2013;88(8):1088-1094.

Kennedy TJT, Regehr G, Baker GR, Lingard L. Point-of-care assessment of medical trainee competence for independent
clinical work. Acad Med. 2008;83(10):S89-S92.
Peters H, Holzhausen Y, Boscardin C, ten Cate O, Chen HC. Twelve tips for the implementation of EPAs for assessment and
entrustment decisions. Med Teach. 2017;39(8):802-807.
Rekman J, Hamstra SJ, Dudek N, Wood T, Seabrook C, Gofton W. A new instrument for assessing resident competence in
surgical clinic: the Ottawa clinic assessment tool. J Surg Educ. 2016;73(4):575-582.

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