S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-3572-5971 .
A. Gingerich is assistant professor, Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada; ORCID: http://orcid.org/0000-0001-5765-3975 .
Acad Med. 2021 Jul 1;96(7S):S76-S80. doi: 10.1097/ACM.0000000000004094.
Entrustable professional activities (EPAs) describe activities that qualified professionals must be able to perform to deliver safe and effective care to patients. The entrustable aspect of EPAs can be used to assess learners through documentation of entrustment decisions, while the professional activity aspect can be used to map curricula. When used as an assessment framework, the entrustment decisions reflect supervisory judgments that combine trainees' relational autonomy and patient safety considerations. Thus, the design of EPAs incorporates the supervisor, trainee, and patient in a way that uniquely offers a link between educational outcomes and patient outcomes. However, achieving a patient-centered approach to education amidst both curricular and assessment obligations, educational and patient outcomes, and a supervisor-trainee-patient triad is not simple nor guaranteed. As medical educators continue to advance EPAs as part of their approach to competency-based medical education, the authors share a critical discussion of how patients are currently positioned in EPAs. In this article, the authors examine EPAs and discuss how their development, content, and implementation can result in emphasizing the trainee and/or supervisor while unintentionally distancing or hiding the patient. They consider creative possibilities for how EPAs might better integrate the patient as finding ways to better foreground the patient in EPAs holds promise for aligning educational outcomes and patient outcomes.
可委托的专业活动 (EPAs) 描述了合格的专业人员必须能够执行的活动，以向患者提供安全有效的护理。EPAs 的可委托方面可用于通过委托决策的记录来评估学习者，而专业活动方面可用于映射课程。当用作评估框架时，委托决策反映了结合学员的关系自主性和患者安全考虑的监督判断。因此，EPAs 的设计将主管、学员和患者纳入其中，以一种独特的方式将教育成果与患者成果联系起来。然而，在课程和评估义务、教育和患者成果以及主管-学员-患者三方之间实现以患者为中心的教育方法并不简单，也无法保证。随着医学教育工作者继续将 EPAs 作为其基于能力的医学教育方法的一部分，作者分享了对当前患者在 EPAs 中的定位的批判性讨论。在本文中，作者检查了 EPAs，并讨论了它们的开发、内容和实施如何导致强调学员和/或主管，而无意中疏远或隐藏患者。他们考虑了 EPAs 如何更好地将患者整合在一起的创造性可能性，因为找到更好地将患者放在 EPAs 中的方法有望使教育成果和患者成果保持一致。
