Journal of General Internal Medicine

, Volume 28, Issue 8, pp 1110–1114 | Cite as

Developing Entrustable Professional Activities as the Basis for Assessment of Competence in an Internal Medicine Residency: A Feasibility Study

  • Karen E. HauerEmail author
  • Krishan Soni
  • Patricia Cornett
  • Jeff Kohlwes
  • Harry Hollander
  • Sumant R. Ranji
  • Olle ten Cate
  • Eric Widera
  • Brook Calton
  • Patricia S. O’Sullivan
Innovations and Improvement: Innovations in Medical Education



Graduate medical education programs assess trainees’ performance to determine readiness for unsupervised practice. Entrustable professional activities (EPAs) are a novel approach for assessing performance of core professional tasks.


To describe a pilot and feasibility evaluation of two EPAs for competency-based assessment in internal medicine (IM) residency.


Post-graduate year-1 interns (PGY-1s) and attendings at a large internal medicine (IM) residency program.


Two Entrustable professional activities (EPA) assessments (Discharge, Family Meeting) were piloted.


Twenty-eight out of 43 (65.1 %) PGY-1 s and 32/43 (74.4 %) attendings completed surveys about the Discharge EPA experience. Most who completed the EPA assessment (10/12, 83.8 %, PGY-1s; 9/11, 83.3 %, attendings) agreed it facilitated useful feedback discussions. For the Family Meeting EPA, 16/26 (61.5 %) PGY-1s completed surveys, and most who participated (9/12 PGY1s, 75 %) reported it improved attention to family meeting education, although only half recommended continuing the EPA assessment.


From piloting two EPA assessments in a large IM residency, we recognized our reminder systems and time dedicated for completing EPA requirements as inadequate. Collaboration around patient safety and palliative care with relevant clinical services has enhanced implementation and buy-in. We will evaluate how well EPA-based assessment serves the intended purpose of capturing trainees’ trustworthiness to conduct activities unsupervised.


clinical competence assessment education medical graduate medical education 



The authors thank William Iobst, MD, and Kelly Caverzagie, MD for sharing their expertise at our planning retreats, Sue Sheehan for administrative support, and Joanne Batt for data management.


Dr. Hauer received support from the American Board of Internal Medicine. There was no additional funding specific to this project.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2013_2372_MOESM1_ESM.docx (47 kb)
ESM 1 (DOCX 47 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Karen E. Hauer
    • 1
    Email author
  • Krishan Soni
    • 1
  • Patricia Cornett
    • 2
  • Jeff Kohlwes
    • 2
  • Harry Hollander
    • 1
  • Sumant R. Ranji
    • 1
  • Olle ten Cate
    • 1
    • 3
  • Eric Widera
    • 2
  • Brook Calton
    • 1
  • Patricia S. O’Sullivan
    • 1
  1. 1.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Medicine, San Francisco Veterans Affairs Medical CenterUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of MedicineUtrecht UniversityUtrechtThe Netherlands

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