gms | German Medical Science

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

05.10. - 08.10.2011, München

Competency-based medical education: how Entrustable Professional Activities can translate competencies to the real world


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  • corresponding author presenting/speaker Th. J. Olle ten Cate - Universi8ty Medical Center Utrecht, Center of Research and Development of Education, Utricht, The Netherlands

Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA). München, 05.-08.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gma284

doi: 10.3205/11gma284, urn:nbn:de:0183-11gma2840

Published: September 26, 2011

© 2011 ten Cate.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



There is no disagreement that physicians must be educated to be “competent”. The definition of competence and the methods to assess it however have caused considerable debate. Competency-based medical education has been introduced to more clearly define what a competent doctor is and to ensure that programs do not graduate doctors of insufficient level. CanMEDS, ACGME and other competency frameworks have been welcomed as they better describe physicians’ qualities. After their acceptance, the translation of such frameworks into teaching and assessment in practice is found to be less easy. Detailing and translating competencies into observable behaviour often leads to extensive descriptions that are hard to work with.

Entrustable Professional Activities (EPAs) as a concept was designed to turn back to medical practice, as the heart of medical education and as the starting point for teaching, assessment and the mapping of competencies. EPAs can be defined as units of professional practice, to be entrusted to trainees once they have shown sufficient competence to act unsupervised. All EPAs together constitute a specific profession. Working with EPAs and formal entrustment decisions has many potential advantages, among which to serve as milestones in development, to operationalize a time-independent, but truly competency-based progression, to stimulate patient-safe training and practice, to guide the practice of supervision and to ease portfolio-based licensure.