Entrustable Professional Activities: Building Core Skills and Expectations

By Andrew Mays, PharmD, CNSC, Clinical Pharmacy Specialist, University of Mississippi Medical Center

As a preceptor for student pharmacists, pharmacy residents, and medical fellows, I sometimes ask myself if I am providing my trainees the best training to prepare them for practice.  While each individual has different professional goals, it is my responsibility to ensure that each trainee has been adequately prepared for the professional roles they will have in the future.  Sometimes, my perspective is clouded by a trainee’s background or career ambitions.  Precepting trainees from multiple professional programs often make it difficult to meet each institution’s unique requirements.  This can leave preceptors with questions about what each student’s experience must include or what to skills to focus on.  Entrustable professional activities (EPAs) provide preceptors a common structure for practice-based experiences.¹

Healthcare is constantly evolving and training programs for each healthcare profession must change to meet the needs of patients. This evolution also impacts the education of students within professional programs.  To maintain consistency, leaders within health professions education must determine how to evaluate student progression and determine when a trainee is ready for practice.  EPAs give preceptors a set of expectations and leads to appropriate and effective feedback.  EPAs also address potential differences between schools and postgraduate training programs.  EPAs can be leveraged to determine trainee competency in “real-life” clinical settings.^1,2

The American Association of Colleges of Pharmacy’s Academic Affairs Standing Committee recently developed the Core Entrustable Professional Activities (EPAs) for New Pharmacy Graduates.³ EPAs are units of professional practice and descriptors of work that are independently executable, observable, and measurable in process and outcome.  These core EPAs were identified as activities or tasks that all new pharmacy graduates must be able to perform without direct supervision when entering practice or post-graduate training.⁴

Recently published research in the American Journal of Health-System Pharmacy looked at the validity of the Core EPAs for New Pharmacy Graduates.⁵ This prospective study asked experienced pharmacy preceptors to complete a 28-item survey that included questions regarding the Core EPAs, the EPA role categories, and respondent demographics. These practitioners supervised students on introductory and advanced pharmacy practice experiences.  To be eligible for the study, the respondents must have supervised at least 6 students over the previous 24 months. The participants in this study represented diverse backgrounds and practice settings. Respondents were full-time, part-time, and volunteer/adjunct faculty and practiced in acute care, long-term care, ambulatory care, and other diverse pharmacy practice settings.

Respondents consistently agreed (>75%) that the EPA statements were pertinent to pharmacy practice and reflected activities that pharmacists are supposed to do in every pharmacy practice setting.

The results of this study show that experienced highly-credentialed preceptors agree that the EPA statements are valid expectations.  Moreover, the EPA statements are focused, observable, and transferable to multiple settings.  However, this study did not survey new practitioner, staff pharmacists, or administrators – groups that might have different opinions about the relevance and applicability of the EPAs.  Also, students and residents were not included in this study.  The viewpoint of pharmacy students or residents may give important information in order to determine the feasibility of the EPAs during training.

EPAs describe the activities that encompass the day to day activities of healthcare professionals.  One important element that has not been adequately addressed is the concept of “trust.”  How will preceptors determine whether a trainee can be “entrusted” to perform these activities?  And if trainees do not demonstrate an adequate level of ability, what is an appropriate intervention?

Along with identifying the critical skills needed to care for patients, EPAs empower preceptors to tailor rotations to better prepare students for practice.  As the use of EPAs increases and students are more consistently prepared for practice, postgraduate training programs should witness a more consistent baseline of knowledge and skill for entering residents.  This will not eliminate students having variations in clinical experiences, but it will allow for post-graduate training programs to build on the expected core.

References

1. Pittenger AL, Chapman SA, Frail CK, et al. Entrustable Professional Activities for Pharmacy Practice. Am J Pharm Educ. 2016 May 25;80(4): Article 57.
2. Association of American Medical Colleges. Core Entrustable Professional Activities for Entering Residency: Curriculum Developers’ Guide. https://members.aamc.org/eweb/upload/Core%20EPA%20Curriculum%20Dev%20Guide.pdf (accessed October 15, 2018).
3. Haines ST, Pittenger AL, Stolte SK, et al. Core Entrustable Professional Activities for New Pharmacy Graduates. Am J Pharm Educ. 2017 25;81(1): Article S2.
4. American Association of Colleges of Pharmacy. Core EPA Domains and Example Supporting Tasks (Appendix1).
   
   https://www.aacp.org/resource/entrustable-professional-activities-epas (accessed October 8, 2018).
5. Haines ST, Pittenger AL, Gleason BL, et al. Validation of the entrustable professional activities for new pharmacy graduates. Am J Health-Syst Pharm. 2018;75: e661-8.