CBVE Entrustable Professional Activities (EPAs)

Entrustable Professional Activities are essential activities that veterinarians perform in the workplace. These activities are described at a high level so that they can be performed and observed in variable contexts (e.g., different species, clients, settings).

EPAs are:

• Complex activities that require integration of multiple competencies from multiple domains and are performed in the authentic workplace environment;

• Observable activities with a defined beginning and end;

• Activities that require learners to take responsibility for their decisions where there are real consequences;

• Activities learners should be entrusted to perform independently at the time of graduation.

EPAs are not:

• Activities for which specialized training or experience beyond veterinary school is required in order to perform;

• Activities that are performed in a simulated environment;

• Simple skills or activities that require only one competency.

There are eight EPAs published within the CBVE Model. These EPAs are considered core for all veterinary graduates. Schools may create additional EPAs that are important to their local context, but the total number of EPAs should be limited (8-12) to ensure that each student can be assessed performing each EPA multiple times across clinical training.

EPAs can be used to provide formative and/or summative assessment opportunities for learners and often contribute to a program of assessment. Assessment of a learner’s ability to perform an EPA represents a snapshot in time; EPAs are most effective when used across the clinical training experience in a variety of contexts and are useful in assessing longitudinal progression of an individual learner.

Entrustment-supervision (ES) scales are commonly used to assess a learner’s ability to perform an EPA independently. ES scales can be employed retrospectively, where evaluators report the level of supervision required for the learner to perform the activity or prospectively, where evaluators report how much trust they would place in the learner if performing the same task again.

Assessment of EPAs requires direct observation of the learner performing the EPA. In some cases, it may be more practical to observe a portion of the EPA, a subsection of the activity which can be assessed independently from the rest of the EPA (i.e., nested EPA). An example is EPA 1: Gathers a history, performs an examination and creates a prioritized differential diagnosis list. In clinical training, EPA 1 may be divided into separate nested EPAs: 1a. Gathers a history; 1b. Performs an examination; 1c. Creates a prioritized differential diagnosis list. A learner could be observed performing nested EPA 1a on one patient and nested EPA 1b on a different patient.

Guide to this section:

Each EPA is summarized and followed by a more detailed commentary about the activity to help readers understand the context. The relationship between each EPA and the domains of competence and competencies follows.

The most relevant domains of competence for each EPA are listed and depicted by large icons. The secondary domains are also listed and defined by smaller icons. Less relevant domains for a particular EPA are shown in gray. Specific elements within the EPA are then listed along with the specific competencies that map to each element. This mapping is useful for developing assessment rubrics.