The AFMC Entrustable Professional Activities: What every graduating medical student must learn

OTTAWA, April 18, 2017 – Trust: That is the key facet of the relationship between a patient and their doctor. Trust within the health care system means doctors and health care teams trust that each is able to do what they do. Entrustable Professional Activities mean a doctor’s ability to understand their own limitations and knowing when to ask for help. Clinical activities that trainees can be trusted to perform with minimal or no supervision have been labeled as Entrustable Professional Activities (EPAs).

AFMC is pleased to announce its 12 Entrustable Professional Activities (EPAs) for every Canadian medical school graduate are enthusiastically being integrated into our medical curricula, with astounding success. This is a true Canadian innovation to ensure that the education of our graduating medical students is at its best when they enter their residency. In sum, if all students can be trusted to have attained these agreed-upon EPAs we protect patient safety and a smooth transition from medical to front-line patient care by residents. Importantly for graduating medical students the competencies for EPAs are now fully transparent. For students this is a positive outcome: clear expectations upon which they can build a relationship of trust with patients and supervisors.

The 12 core activities required prior to starting residency were developed by the AFMC EPA Working Group, which was co-chaired by AFMC Past Vice-President Education, Dr. Andrée Boucher and content expert Dr. Claire Touchie, Chief Medical Education Advisor at the Medical Council of Canada. “The AFMC EPAs are specific to the Canadian medical education and clinical practice context and are a clear, concise list of what graduating medical students should be entrusted to do without direct supervision on DAY ONE of residency,” explains Dr. Andrée Boucher.

After having received full endorsement from undergraduate and postgraduate deans, as well as the 4 learner organizations (CFMS, FMEQ, FMRQ and RDoC), the AFMC EPAs were officially launched in September 2016. The implementation phase has now begun, which, according to Dr. Claire Touchie “is meant to be asynchronous and gradual. One school is assessing aspects of clerkship using the AFMC EPAs, while some schools are fully or partially implementing them in their curricula later in 2017 or in 2018. Other schools are still in discussion as how to best implement them”.

“Why are we doing this? Because before the EPAs there was no consensus about the common behaviors and activities for graduating medical students and the EPAs accomplish this agreement across all our Canadian medical schools” says AFMC President and CEO, Dr. Geneviève Moineau. “The AFMC Entrustable Professional Activities are significantly reassuring for the public as they guarantee quality patient care to an even higher degree”.

The 12 AFMC EPAs every doctor should know:

1-Obtain a history and perform a physical examination adapted to the patient’s clinical situation

2-Formulate and justify a prioritized differential diagnosis

3-Formulate an initial plan of investigation based on the diagnostic hypotheses

4-Interpret and communicate results of common diagnostic and screening tests

5-Formulate, communicate and implement management plans

6-Present oral and written reports that document a clinical encounter

7-Provide and receive the handover in transitions of care

8-Recognize a patient requiring urgent or emergent care, provide initial management and seek help

9-Communicate in difficult situations

10-Participate in health quality improvement initiatives

11-Perform general procedures of a physician

12-Educate patients on disease management, health promotion and preventive medicine