title: Flexibility in individualized, competency-based workplace curricula with EPAs: Analyzing four cohorts of physician assistants in training.
abstract: BACKGROUND
  Entrustable professional activities (EPAs) were introduced as a principle for individualized physician assistant (PA) workplace curricula at the University of Applied Sciences (UAS) Utrecht in 2008. We studied how the focus on EPAs served the competency-based flexibility intention of the program.
  
  
  METHODS
  We analyzed data of those 119 students who enrolled in the program 2010 through 2013, and completed the program before April 2016. We analyzed the number of EPAs per student at start and end of the program, number changed during training and the reasons for change.
  
  
  RESULTS
  Data of 101 students were suitable for evaluation. Excluded were 16 students ending the program prematurely and two with study delay. Mean number of EPAs per student at the start was 6.8 (range 4-12) and at the end 6.6 (range 3-13). On average 1.5 EPAs were altered (range 0-13). Reasons included extension of the EPA package during training (n = 10), lack of proficiency at planned moments of summative entrustment decisions (n = 9) and procedures not being suitable for PAs at closer look (n = 6). All changes resulted in a curriculum meeting the school's standards for graduation.
  
  
  CONCLUSIONS
  The flexibility of the EPA concept enabled changes in the individualized curriculum of students, according to the intended competency-based nature of the educational program.
authors.affiliation: a Faculty of Health Care , University of Applied Sciences, Utrecht , The Netherlands.
authors.forename: Fraukje
authors.initials: F
authors.lastname: Wiersma
authors.affiliation: a Faculty of Health Care , University of Applied Sciences, Utrecht , The Netherlands.
authors.forename: Josephine
authors.initials: J
authors.lastname: Berkvens
authors.affiliation: b Center for Research and Development of Education, University Medical Center, Utrecht , The Netherlands.
authors.forename: Olle
authors.initials: O
authors.lastname: Ten Cate
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods* / Q000458:organization & administration*; D003479:Curriculum; D006801:Humans; D007858:Learning; D010823:Physician Assistants / Q000193:education* / Q000523:psychology; D016730:Program Development; D015397:Program Evaluation; D017132:Workplace