Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency.
Currently, no standard defines the clinical skills that medical students must demonstrate upon graduation. The Liaison Committee on Medical Education bases its standards on required subject matter and student experiences rather than on observable educational outcomes. The absence of such established outcomes for MD graduates contributes to the gap between program directors' expectations and new residents' performance.In response, in 2013, the Association of American Medical Colleges convened a panel of experts from undergraduate and graduate medical education to define the professional activities that every resident should be able to do without direct supervision on day one of residency, regardless of specialty. Using a conceptual framework of entrustable professional activities (EPAs), this Drafting Panel reviewed the literature and sought input from the health professions education community. The result of this process was the publication of 13 core EPAs for entering residency in 2014. Each EPA includes a description, a list of key functions, links to critical competencies and milestones, and narrative descriptions of expected behaviors and clinical vignettes for both novice learners and learners ready for entrustment.The medical education community has already begun to develop the curricula, assessment tools, faculty development resources, and pathways to entrustment for each of the 13 EPAs. Adoption of these core EPAs could significantly narrow the gap between program directors' expectations and new residents' performance, enhancing patient safety and increasing residents', educators', and patients' confidence in the care these learners provide in the first months of their residency training.
R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, Washington, DC, at the time this work was done. He is now associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota.T. Flynn is senior associate dean for clinical affairs, University of Florida College of Medicine, Gainesville, Florida.S. Call is program director for internal medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.C. Carraccio is vice president for competency-based assessment programs, American Board of Pediatrics, Chapel Hill, North Carolina.L. Cleary is vice president for academic affairs, State University of New York Upstate Medical University, Syracuse, New York.T.B. Fulton is professor of biochemistry and biophysics and competency director for medical knowledge, University of California, San Francisco, School of Medicine, San Francisco, California.M.J. Garrity is associate professor of medicine and physiology and associate dean, University of Colorado Anschutz Medical Campus, Aurora, Colorado.S.A. Lieberman is senior dean for administration, University of Texas Medical Branch School of Medicine, Galveston, Texas.B. Lindeman is chief resident, Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.M.L. Lypson is professor of internal medicine and learning health sciences, University of Michigan Medical School, and associate chief of staff for education, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.R.M. Minter was associate professor of surgery and learning health sciences, associate chair for education, Department of Surgery, and associate program director in general surgery, University of Michigan Medical School, Ann Arbor, Michigan, at the time this work was done. She is now professor and Alvin Baldwin Jr. Chair, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.J. Rosenfield is vice dean of the MD program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.J. Thomas is a resident in emergency medicine, Mayo Clinic, Rochester, Minnesota.M.C. Wilson is clinical professor of internal medicine and associate dean for graduate medical education, University of Iowa Carver College of Medicine, and designated institutional official, University of Iowa Hospitals and Clinics, Iowa City, Iowa.C.A. Aschenbrener was chief medical education officer, Association of American Medical Colleges, Washington, DC, at the time this work was done.
Robert
R
Englander
Timothy
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Flynn
Stephanie
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Call
Carol
C
Carraccio
Lynn
L
Cleary
Tracy B
TB
Fulton
Maureen J
MJ
Garrity
Steven A
SA
Lieberman
Brenessa
B
Lindeman
Monica L
ML
Lypson
Rebecca M
RM
Minter
Jay
J
Rosenfield
Joe
J
Thomas
Mark C
MC
Wilson
Carol A
CA
Aschenbrener