Epaology and the importance of context
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Perspect Med Educ (2020) 9:331–332 https://doi.org/10.1007/s40037-020-00638-5
Epaology and the importance of context F. Scheele
Received: 13 November 2020 / Revised: 13 November 2020 / Accepted: 17 November 2020 / Published online: 2 December 2020 © The Author(s) 2020
Van Enk and Ten Cate have provided an interesting perspective concerning entrustment [1]. Entrustment is part of the Entrustable Professional Activity (EPA) concept described by Ten Cate and others. Since 2007, the EPA has been introduced in many countries and several articles were published that deepen our understanding of why EPAs may be used and of the potential benefits and pitfalls in practice. In their perspective, Van Enk and Ten Cate recognize that entrustment is used both in retrospective and prospective assessments. In retrospective assessments, the assessor records how much supervision was given while the resident was performing a professional activity. In prospective assessments, often a team of assessors decides whether we can entrust the resident for the future. The authors raised the question whether professional ‘gut feeling judgement’ without clearly defined standards and measures is appropriate for assessors concerned with entrustment. Moreover, they propose further research into the language used for subjective assessments. They argue that ‘to limit evidence in assessment only to knowledge that can be fully and formally languaged would be naïve and would impoverish assessment’. In this commentary I shall take a step back and reflect on the need for uniform interpretation of the EPA concept. I shall argue that there is no universal truth and the EPA concept is best adapted to a national or even local context, as long as it optimally supports teaching and assessment. The same applies to the use of subjective assessments for entrustment. In 2005, Olle ten Cate first proposed the concept of entrustment of professional activities in reaction to the granularity of competency frameworks and the divergence between educational theory and clinical F. Scheele () Amsterdam UMC, Amsterdam, The Netherlands [email protected]
practice [2]. In 2007, Olle and I wrote an article in which we placed the concept in a clinical context [3]. This article was written at a strategic level, and attributes of the EPA concept were based on the Obstetrics and Gynaecology program in the Netherlands. Attributes comprised a careful selection of concrete critical clinical activities, the connection of general competencies with clinical activities and a more holistic assessment focus on these clinical activities rather than on separate competencies. The clinical activities chosen would represent the specialism and cover a wide range of competencies as defined in competency frameworks. The entrustment of the chosen clinical activities would allow for stepwise independent practice during residency and a flexible duration of rotations within a training program, depending on learning curves. A nationwide and later on worldwide implementation was started and several i
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