EPA 1: Gather a History and Perform a Physical Examination Key Functions Behaviors  Developing Behaviors  Expected Behaviors for an with Related (Learner may be at different levels within a row.) Entrustable Learner An EPA: A unit of Requiring observable, measurable Competencies Corrective Gathers excessive or incomplete data Uses a logical progression of Obtains a complete and accurate professional practice Response questioning history in an organized fashion requiring integration of Obtain a complete Does not collect Does not deviate from a template competencies and accurate history Questions are prioritized and Seeks secondary sources of in an organized accurate historical not excessive information when appropriate (e.g. fashion data family, primary care physician, living facility, pharmacy) Relies exclusively PC2 on secondary Adapts to different care settings sources or and encounters EPA 1 documentation of Demonstrate others patient-centered Communicates unidirectionally Demonstrates effective Adapts communication skills to the Is disrespectful in Gather a communication skills, including individual patient’s needs and interview skills interactions with history Does not respond to patient verbal and silence, open-ended characteristics patients nonverbal cues and ICS1 ICS7 P1 P3 P5 questions, body language, listening, and avoids jargon Responds effectively to patient’s perform a May generalize based on age, gender, verbal and nonverbal cues and physical Disregards patient culture, race, religion, disabilities, and/or Anticipates and interprets emotions privacy and sexual orientation patient’s emotions exam autonomy Does not consistently consider patient Incorporates responses privacy and autonomy appropriate to age, gender, culture, race, religion, Demonstrate clinical disabilities and/or sexual Underlying entrustability for reasoning in orientation all EPAs are trustworthy gathering focused habits, including information relevant Fails to recognize Questions are not guided by the evidence Questions are purposefully Demonstrates astute clinical truthfulness, to a patient’s care patient’s central and data collected used to clarify patient’s issues reasoning through targeted conscientiousness, and problem hypothesis-driven questioning discernment. Does not prioritize or filter information Is able to filter signs and KP1 symptoms into pertinent Incorporates secondary data into Questions reflect a narrow differential positives and negatives medical reasoning Perform a clinically diagnosis relevant, appropriately Performs basic exam maneuvers Targets the exam to areas Performs an accurate exam in a This schematic depicts development of thorough physical Does not consider proficiency in the Core EPAs. It is not patient’s privacy correctly necessary for the encounter logical and fluid sequence intended for use as an assessment exam pertinent to and comfort during instrument. Entrustment decisions the setting and exams Does not perform exam in an organized Identifies and describes Uses the exam to explore and should be made after EPAs have been purpose of the fashion normal findings prioritize the working differential observed in multiple settings with varying diagnosis patient visit Incorrectly performs Relies on head-to-toe examination context, acuity, and complexity and with Explains exam maneuvers to basic physical exam Can identify and describe normal varying patient characteristics. patient PC2 maneuvers Misses key findings and abnormal findings

Barron, B, Orlander, P, Schwartz, ML. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 9 EPA 2: Prioritize a Differential Diagnosis Following a Clinical Encounter Behaviors Requiring An EPA: A unit of Key Functions with observable, measurable Related Competencies Corrective  Developing Behaviors  Expected Behaviors for an Response professional practice Synthesize essential (Learner may be at different levels within a row.) Entrustable Learner requiring integration of Cannot gather or Approaches assessment from a rigid Gathers pertinent data based Gathers pertinent information from competencies information from previous synthesize data to template on initial diagnostic many sources in a hypothesis-driven records, history, physical inform an acceptable hypotheses fashion exam, and initial diagnostic diagnosis Struggles to filter, prioritize, and make evaluations to propose a connections between sources of Proposes a reasonable Filters, prioritizes, and makes scientifically supported information differential diagnosis but may connections between sources of Lacks basic medical differential diagnosis neglect important diagnostic information EPA 2 knowledge to reason Proposes a differential diagnosis that is information effectively too narrow, is too broad, or contains Proposes a relevant differential PC2 KP3 KP4 KP2 inaccuracies Is beginning to organize diagnosis that is neither too broad nor knowledge by illness scripts too narrow Demonstrates difficulty retrieving (patterns) to generate and knowledge for effective reasoning support a diagnosis Organizes knowledge into illness Prioritize a scripts (patterns) that generate and differential Prioritize and continue to Disregards emerging support a diagnosis diagnosis integrate information as it diagnostic information Does not integrate emerging Considers emerging Seeks and integrates emerging information to update the differential information but does not information to update the differential emerges to update Becomes defensive and/or diagnosis completely integrate to diagnosis differential diagnosis, while belligerent when update the differential managing ambiguity questioned on differential Displays discomfort with ambiguity diagnosis Encourages questions and challenges diagnosis from patients and team PC4 KP3 KP4 PPD8 PBL1 Acknowledges ambiguity and Underlying entrustability is open to questions and for all EPAs are Ignores team’s trustworthy habits, Engage and communicate challenges recommendations Recommends a broad range of Recommends diagnostic Proposes diagnostic and including truthfulness, with team members for conscientiousness, and untailored diagnostic evaluations evaluations tailored to the management plans reflecting team’s discernment. endorsement and verification Develops and acts on a evolving differential diagnosis input of the working diagnosis that management plan before Depends on team for all management after having consulted with This schematic depicts development will inform management receiving team’s plans team Seeks assistance from team of proficiency in the Core EPAs. It is endorsement members not intended for use as an plans assessment instrument. Entrustment Does not completely explain and Explains and documents decisions should be made after EPAs KP3 KP4 ICS2 Cannot explain or document reasoning clinical reasoning Provides complete and succinct have been observed in multiple document clinical documentation explaining clinical settings with varying context, acuity, and complexity and with varying reasoning reasoning patient characteristics.

Green, M, Tewksbury, L, Wagner, D. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program 28 Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. EPA 3: Recommend and Interpret Common Diagnostic and Screening Tests

Key Functions with Behaviors An EPA: A unit of Related Competencies Requiring observable, measurable Corrective   Expected Behaviors for an professional practice Recommend first-line Developing Behaviors requiring integration of cost-effective screening Response (Learner may be at different levels within a row.) Entrustable Learner competencies and diagnostic tests for Unable to recommend Recommends tests for Considers costs Recommends key, reliable, cost- routine health a standard set of common conditions effective screening and diagnostic maintenance and screening or diagnostic Identifies guidelines for tests common disorders tests Does not consider harm, standard tests costs, guidelines, or Applies patient-specific guidelines Demonstrates patient resources Repeats diagnostic tests PC5 PC9 SBP3 PBLI9 EPA 3 frustration at cost- at intervals that are too KP1 KP4 containment efforts Does not consider frequent or too lengthy patient-specific screening unless Diagnostic instructed and Provide rationale for screening Recommends Understands pre- and Provides individual rationale based decision to order tests, Cannot provide a unnecessary tests or posttest probability on patient’s preferences, tests taking into account pre- rationale for ordering tests with low pretest demographics, and risk factors and posttest probability tests probability Neglects impact of false and patient preference positive or negative results Incorporates sensitivity, specificity, Neglects patient’s and prevalence in recommending and interpreting tests PC5 PC7 KP1 KP4 preferences Aware of patient’s preferences SBP3 PBLI9 Explains how results will influence Underlying diagnosis and evaluation entrustability for all EPAs are trustworthy habits, including truthfulness, conscientiousness, Can only interpret Misinterprets Recognizes need for Distinguishes common, insignificant and discernment. results based on insignificant or assistance to evaluate abnormalities from clinically normal values from the explainable urgency of results and important findings Interpret results of basic lab abnormalities communicate these to studies and understand This schematic depicts development patient Discerns urgent from nonurgent Does not discern of proficiency in the Core EPAs. It is the implication and Does not know how to results and responds correctly urgent from nonurgent not intended for use as an urgency of the results respond to urgent test assessment instrument. Entrustment results results Seeks help for interpretation of tests decisions should be made after EPAs PC4 PC5 PC7 KP1 beyond scope of knowledge have been observed in multiple Requires supervisor to settings with varying context, acuity, discuss results with and complexity and with varying patient patient characteristics.

Biskobing, D, Chang, L, Thompson-Busch, A. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 47 EPA 4: Enter and Discuss Orders and Prescriptions

An EPA: A unit of Behaviors  Developing Behaviors  Expected Behaviors for an observable, measurable Key Functions with Requiring (Learner may be at different levels within a row.) Entrustable Learner professional practice Related Corrective Does not recognize when to tailor or Recognizes when to tailor or deviate Routinely recognizes when to tailor requiring integration of Competencies Response deviate from the standard order set from the standard order set or deviate from the standard order competencies set Compose orders Unable to compose or Orders tests excessively (uses shotgun Completes simple orders efficiently and enter electronic orders approach) Able to complete complex orders or write prescriptions effectively verbally, on Demonstrates working knowledge of requiring changes in dose or (or does so for the May be overconfident, does not seek how orders are processed in the frequency over time (e.g., a taper) paper, and electronically wrong patient or using review of orders workplace an incorrect order set) PC6 PBLI1 Undertakes a reasoned approach to Asks questions, accepts feedback placing orders (e.g., waits for EPA 4 Does not follow contingent results before ordering established protocols more tests) for placing orders Enter and Recognizes limitations and seeks helps discuss Demonstrate an Lacks basic knowledge understanding of the needed to guide orders Has difficulty filtering and synthesizing Articulates rationale behind orders Recognizes patterns, takes into orders and information to prioritize diagnostics and account the patient’s condition patient’s condition that May not take into account subtle signs prescriptions Demonstrates therapies when ordering diagnostics and/or underpins the provided defensiveness when or exam findings guiding orders therapeutics orders questioned Unable to articulate the rationale behind orders Explains how test results influence PC5 PC2 clinical decision making

Recognize and avoid Discounts information Underuses information that could help May inconsistently apply safe Routinely practices safe habits errors by attending to obtained from avoid errors prescription-writing habits such as when writing or entering Underlying patient-specific factors, resources designed to double-check of patient’s weight, age, prescriptions or orders Relies excessively on technology to entrustability for all using resources, and avoid drug–drug renal function, comorbidities, dose EPAs are trustworthy interactions highlight drug–drug interactions and/or and/or interval, and pharmacogenetics Responds to EHR’s safety alerts appropriately habits, including risks (e.g., smartphone or EHR suggests when applicable and understands rationale for them truthfulness, responding to safety Fails to adjust doses an interaction, but learner cannot explain conscientiousness, alerts when advised to do so relevance) Uses electronic resources to fill in and discernment. by others gaps in knowledge to inform safe PBLI7 order writing (e.g., drug–drug Ignores alerts interactions, treatment guidelines) This schematic depicts development of proficiency in the Core EPAs. It is not intended for Discuss planned orders Places orders and/or Places orders without communicating Modifies plan based on patient’s Enters orders that reflect use as an assessment instrument. prescriptions that and prescriptions with with others; uses unidirectional style preferences bidirectional communication with Entrustment decisions should be directly conflict with (“Here is what we are doing...”) patients, families, and team made after EPAs have been team, patients, and patient’s and family’s May describe cost-containment efforts observed in multiple settings with families health or cultural beliefs Does not consider cost of orders or as externally mandated and interfering Considers the costs of orders and varying context, acuity, and patient’s preferences with the doctor–patient relationship the patient’s ability and willingness complexity and with varying patient ICS1 SBP3 characteristics. to proceed with the plan

Mejicano, G, Ryan, M, Vasilevskis, EE., Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program 65 Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. EPA 5: Document a Clinical Encounter in the Patient Record Key Functions Behaviors with Related Requiring   Expected Behaviors for an Competencies Corrective Developing Behaviors (Learner may be at different levels within a row.) Entrustable Learner An EPA: A unit of Response observable, measurable Prioritize and synthesize Misses key information Provides key information but Provides a verifiable cogent narrative information into a cogent Provides incoherent professional practice may include unnecessary without unnecessary details or narrative for a variety of documentation requiring integration of clinical encounters (e.g., Uses a template with limited ability to details or redundancies redundancies competencies admission, progress, pre- adjust or adapt based on audience, and post-op, and context, or purpose Demonstrates ability to adjust Adjusts and adapts documentation procedure notes; or adapt to audience, context, based on audience, context, or informed consent; discharge summary) or purpose purpose (e.g., admission, progress, pre- and post-op, and procedure notes; P4 ICS1 informed consent; discharge summary)

Produces documentation that has Recognizes and corrects errors Provides accurate, legible, timely Follow documentation Copies and pastes EPA 5 errors or does not fulfill institutional related to required elements of documentation that includes requirements to meet information without requirements (e.g., date, time, documentation institutionally required elements regulations and verification or attribution signature, avoidance of prohibited Document professional abbreviations) Meets needed turnaround time Documents in the patient’s record role expectations for standard documentation a clinical Does not provide in team-care activities Has difficulty meeting turnaround encounter documentation when ICS5 P4 SBP1 expectations, resulting in team May not document the pursuit required Documents use of primary and members’ lack of access to of primary or secondary secondary sources necessary to fill in documentation sources important to the Provides illegible gaps Underlying encounter documentation entrustability for all EPAs are trustworthy Includes Does not document a problem list, Documents a problem list, Documents a problem list, differential habits, including differential diagnosis, plan, clinical differential diagnosis, plan, and diagnosis, and plan, reflecting a truthfulness, inappropriate judgmental reasoning, or patient’s preferences clinical reasoning combination of thought processes and conscientiousness, Document a problem input from other providers and discernment. list, differential language Interprets laboratories by relying on Is inconsistent in interpreting diagnosis, and plan Interprets laboratory values accurately Documents norms rather than context basic tests accurately This schematic depicts supported through clinical reasoning that potentially damaging Identifies key problems, documenting development of proficiency in the Does not include a rationale for Engages in help-seeking reflects patient’s information without engagement of those who can help Core EPAs. It is not intended for ordering studies or treatment plans behavior resulting in improved preferences attribution resolve them use as an assessment instrument. ability to develop and document Entrustment decisions should be Demonstrates limited help-seeking management plans made after EPAs have been PC4 PC6 ICS1 ICS2 Communicates bidirectionally to behavior to fill gaps in knowledge, develop and record management plans observed in multiple settings with skill, and experience Solicits patient’s preferences aligned with patient’s preferences varying context, acuity, and and records them in a note complexity and with varying patient characteristics. 7

Carter, TJ, Drusin, R, Moeller, J. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program 84 Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. EPA 6: Provide an Oral Presentation of a Clinical Encounter Behaviors Requiring  Developing Behaviors  Expected Behaviors for an An EPA: A unit of Key Functions with Corrective (Learner may be at different levels within a row.) Entrustable Learner observable, measurable Related Response Gathers evidence incompletely or Acknowledges gaps in Presents personally verified and professional practice Competencies exhaustively knowledge, adjusts to feedback, accurate information, even when requiring integration of Fabricates information and then obtains additional sensitive competencies Present personally when unable to Fails to verify information information gathered and verified respond to questions Acknowledges gaps in knowledge, information, Does not obtain sensitive reflects on areas of uncertainty, and acknowledging areas of Reacts defensively information seeks additional information to clarify uncertainty when queried or refine presentation

EPA 6 PC2 PBL1 PPD4 P1 Presents in a Delivers a presentation that is not Delivers a presentation organized Filters, synthesizes, and prioritizes Provide an disorganized and concise or that wanders around the chief concern information into a concise and well- incoherent fashion organized presentation oral Provide an accurate, Presents a story that is imprecise When asked, can identify presentation concise, well-organized because of omitted or extraneous pertinent positives and negatives Integrates pertinent positives and that support hypothesis negatives to support hypothesis of a clinical oral presentation information encounter Supports management plans with Provides sound arguments to ICS2 PC6 limited information support the plan

Presents information Follows a template When prompted, can adjust Adjust the oral in a manner that presentation in length and Tailors length and complexity of presentation to meet frightens family Uses acronyms and medical complexity to match situation and presentation to situation and receiver the needs of the jargon receiver of information of information Underlying entrustability receiver for all EPAs are Projects too much or too little Conveys appropriate self-assurance trustworthy habits, confidence to put patient and family at ease including truthfulness, ICS1 ICS2 PBL1 PPD7 conscientiousness, and discernment. Demonstrate respect for Disregards patient’s Lacks situational awareness when Incorporates patient’s preferences Respects patients’ privacy and This schematic depicts patient’s privacy and privacy and autonomy presenting sensitive patient and privacy needs confidentiality by demonstrating development of proficiency in the information situational awareness when not autonomy Core EPAs. It is intended for discussing patients use as an assessment instrument. Does not engage patients and Entrustment decisions should be P3 P1 PPD4 families in discussions of care Engages in shared decision making made after EPAs have been observed in multiple settings with by actively soliciting patient’s varying context, acuity, and preferences complexity and with varying patient characteristics.

Catallozzi, M, Dunne, D, Noble JM, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 102 EPA 7: Form Clinical Questions and Retrieve Evidence to Advance Patient Care Key Functions with Behaviors Related Competencies Requiring Combine curiosity, Corrective  Developing Behaviors  Expected Behaviors for an objectivity, and scientific Response (Learner may be at different levels within a row.) Entrustable Learner reasoning to develop a With prompting, translates Seeks assistance to translate Identifies limitations and gaps in An EPA: A unit of Does not observable, measurable well-formed, focused, reconsider information needs into clinical information needs into well- personal knowledge professional practice pertinent clinical approach to a questions formed clinical questions requiring integration of question problem, ask for Develops knowledge guided by competencies (ASK) help, or seek well-formed clinical questions new information KP3 PBLI6 PBLI1 PBLI3

Demonstrate awareness Declines to use Uses vague or inappropriate Employs different search Identifies and uses available and skill in using new information search strategies, leading to an engines and refines search databases, search engines, and information technology to technologies unmanageable volume of strategies to improve efficiency refined search strategies to acquire EPA 7 access accurate and information of evidence retrieval relevant information reliable medical information Clinical (ACQUIRE) questions to advance PBLI6 PBLI7 Refuses to Accepts findings from clinical Judges evidence quality from Uses levels of evidence to patient Demonstrate skill in consider gaps studies without critical appraisal clinical studies appraise literature and determines care and limitations in applicability of evidence appraising sources, the literature or With assistance, applies Applies published evidence to content, and applicability apply published evidence to common medical common medical conditions Seeks guidance in understanding of evidence evidence to conditions subtleties of evidence Underlying entrustability specific patient for all EPAs are (APPRAISE) care trustworthy habits, including truthfulness, PBLI6 KP3 KP4 conscientiousness, and Does not discuss Communicates with rigid Applies findings based on Applies nuanced findings by discernment. Apply findings to individuals and/or patient findings with team recitation of findings, using audience needs communicating the level and medical jargon or displaying consistency of evidence with This schematic depicts development panels; communicate Does not personal biases Acknowledges ambiguity of appropriate citation of proficiency in the Core EPAs. It is findings to the patient determine or findings and manages personal not intended for use as an and team, reflecting on discuss outcomes Shows limited ability to connect bias Reflects on ambiguity, outcomes, assessment instrument. Entrustment and/or process, outcomes to the process by and the process by which decisions should be made after EPAs process and outcomes which questions were identified Connects outcomes to process questions were identified and have been observed in multiple (ADVISE) even with settings with varying context, acuity, prompting and answered and findings were by which questions were answered and findings were and complexity and with varying ICS1 ICS2 PBLI1 PBLI8 applied identified and answered applied patient characteristics. PBLI9 PC7 7 Cocks, P, Cutrer, WB, Esposito, K, Lupi, C, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 121 EPA 8: Give or Receive a Patient Handover to Transition Care Responsibility Key Functions with An EPA: A unit of Related Competencies observable, measurable Behaviors Requiring  Developing Behaviors  Expected Behaviors for Document and update an professional practice Corrective Response (Learner may be at different levels within a row.) an Entrustable Learner requiring integration of electronic handover tool and Inconsistently uses Uses electronic handover tool Consistently updates electronic Consistently updates electronic competencies apply this to deliver a structured standardized format or uses handover tool with mostly handover tool with clear, relevant, verbal handover Inconsistently updates tool alternative tool relevant information, applying a and succinct documentation standardized template PBLI7 ICS2 ICS3 P3 Requires clarification and Adapts and applies all elements Provides information that is additional relevant information Adjusts patient information for of a standardized template EPA 8 *Transmitter incomplete and/or includes from others to prioritize information context and audience multiple errors in patient Presents a verbal handover that Conduct handover using Provides patient information that is information May omit relevant information or is prioritized, relevant, and Give or communication strategies known disorganized, too detailed, and/or present irrelevant information succinct to minimize threats to transition too brief receive a Is frequently distracted Requires assistance to minimize Requires assistance with time Avoids interruptions and of care patient interruptions and distractions management distractions handover ICS2 ICS3 Carries out handover with Demonstrates minimal situational Focuses on own handover tasks Manages time effectively inappropriate timing and awareness with some awareness of other’s *Transmitter context needs Demonstrates situational Provide succinct verbal awareness communication conveying illness Communication lacks all key Inconsistently communicates key Identifies illness severity Highlights illness severity severity, situational awareness, components of standardized components of the standardized accurately Underlying action planning, and contingency handover tool Provides incomplete action list entrustability for all planning and contingency planning Provides complete action plans EPAs are Does not provide action plan and and appropriate contingency trustworthy habits, ICS2 PC8 including contingency plan Creates a contingency plan that plans truthfulness, *Transmitter lacks clarity conscientiousness, Give or elicit feedback about Withholds or is defensive Delivers incomplete feedback; Accepts feedback and adjusts Provides and solicits feedback and discernment. handover communication and with feedback accepts feedback when given regularly, listens actively, and engages in reflection ensure closed-loop Summary statements are too This schematic depicts Displays lack of insight on Does not encourage other team development of proficiency in the communication elaborate members to express their ideas or Identifies areas of improvement Core EPAs. It is not intended for the role of feedback opinions use as an assessment instrument. PBLI5 ICS2 ICS3 Inconsistently uses repeat-back Entrustment decisions should be Does not summarize (or Asks mutually clarifying questions, technique made after EPAs have been *Transmitter and Receiver repeat) key points for Inconsistently uses summary provides succinct summaries, and observed in multiple settings with effective closed-loop statements and/or asks clarifying uses repeat-back techniques varying context, acuity, and complexity and with varying communication questions patient characteristics. Demonstrate respect for patient’s Is unaware of HIPAA policies Is aware of HIPAA policies Is cognizant of and attempts to Consistently considers patient privacy and confidentiality minimize breaches in privacy and privacy and confidentiality * Functions are designated as Breaches patient confidentiality “transmitter” or “transmitter and P3 confidentiality and privacy Highlights and respects patient’s receiver.” preferences *Transmitter and Receiver

Aiyer, M, Garber, A, Ownby, A, Trimble, G, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 139 EPA 9: Collaborate as a Member of an Interprofessional Team Behaviors Key Functions with Requiring An EPA: A unit of Related Corrective  Developing Behaviors  Expected Behaviors for an observable, measurable Competencies Response (Learner may be at different levels within a row.) Entrustable Learner professional practice requiring integration of Identify team members’ Does not Identifies roles of other Interacts with other team Effectively partners as an integrated competencies roles and acknowledge other team members but does members, seeks their member of the team responsibilities and members of the not know how or when to counsel, actively listens to Articulates the unique contributions seek help from other interdisciplinary team use them their recommendations, and roles of other health care members of the team to as important and incorporates these Acts independently of input professionals optimize health care recommendations into Displays little initiative from team members, practice delivery Actively engages with the patient and to interact with team patients, and families EPA 9 other team members to coordinate IPC2 SBP2 ICS3 members care and provide for seamless care transition Collaborate as a Include team members, Dismisses input from Communication is largely Listens actively and elicits Communicates bidirectionally; keeps member of an listen attentively, and professionals other unidirectional, in response ideas and opinions from team members informed and up to interprofessional adjust communication than physicians to prompts, or template other team members date team content and style to align with team-member driven Tailors communication strategy to the needs Has limited participation in situation team discussion ICS2/IPC3 IPC1 ICS7 P1 Underlying entrustability for all Establish and maintain Has disrespectful Is typically a more passive Integrates into team Supports other team members and EPAs are trustworthy a climate of mutual interactions or does member of the team function, prioritizing team communicates their value to the habits, including not tell the truth truthfulness, respect, dignity, goals patient and family conscientiousness, integrity, and trust Prioritizes own goals over and discernment. Is unable to modify those of the team Demonstrates respectful Anticipates, reads, and reacts to Prioritize team needs behavior interactions and tells the emotions to gain and maintain This schematic depicts over personal needs to truth therapeutic alliances with others development of proficiency in the Puts others in position Core EPAs. It is not intended for optimize delivery of use as an assessment instrument. care of reminding, Remains professional and Prioritizes team’s needs over personal Entrustment decisions should be enforcing, and anticipates and manages needs made after EPAs have been Help team members in resolving emotional triggers observed in multiple settings with interprofessional varying context, acuity, and need complexity and with varying conflicts patient characteristics. P1 ICS7 IPC1 SBP2 7

Brown, D, Gillespie, C, Warren, J, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 157 EPA 10: Recognize a Patient Requiring Urgent or Emergent Care and Initiate Evaluation and  Developing Behaviors  Expected Behaviors for an Key Functions with Behaviors Management (Learner may be at different levels within a row.) Entrustable Learner Related Requiring Competencies Corrective Demonstrates limited ability to Recognizes outliers or Recognizes variations of patient’s vital gather, filter, prioritize, and unexpected results or data signs based on patient- and disease- An EPA: A unit of Recognize normal and Response connect pieces of information to and seeks out an explanation specific factors observable, measurable abnormal vital signs as Fails to recognize form a patient-specific professional practice they relate to patient- and trends or variations of requiring integration of differential diagnosis in an Gathers, filters, and prioritizes disease-specific factors vital signs in a • Chest pain competencies urgent or emergent setting information related to a patient’s as potential etiologies of decompensating patient • Mental status decompensation in an urgent or a patient’s change emergent setting decompensation • Shortness of Does not recognize Misses abnormalities in Recognizes concerning Responds to early clinical breath and PC2 PC4 PC5 change in patient’s patient’s clinical status or does clinical symptoms or deterioration and seeks timely help hypoxemia not anticipate next steps Recognize severity of a clinical status or seek unexpected results or data • Fever EPA 10 patient’s illness and help when a patient May be distracted by multiple Prioritizes patients who need • Hypotension or indications for escalating requires urgent or problems or have difficulty Asks for help immediate care and initiates critical hypertension Recognize care and initiate emergent care prioritizing interventions • Tachycardia or urgent or interventions and arrhythmia Accepts help management Responds to a Initiates and applies effective airway • Oliguria, emergent Requires prompting to perform Demonstrates appropriate decompensated patient basic procedural or life support airway and basic life support management, BLS, and advanced anuria, or situation cardiovascular life support (ACLS) skills in a manner that urinary PC4 PC3 PC2 PC5 PC6 skills correctly (BLS) skills retention PPD1 detracts from or harms Monitors response to initial interventions and adjusts plan accordingly • Electrolyte team’s ability to Does not engage with other Initiates basic management abnormalities Initiate and participate in intervene team members plans Adheres to institutional procedures and • Hypoglycemia a code response and protocols for escalation of patient care apply basic and Seeks input or guidance from or Uses the health care team members hyperglycemia advanced life support other members of the health according to their roles and care team Underlying responsibilities to increase task efficiency entrustability for all PC1 PPD1 SBP2 IPC4 in an emergent patient condition EPAs are trustworthy habits, including truthfulness, Dismisses concerns of Communicates in a unidirectional Tailors communication and Communicates bidirectionally with the conscientiousness, Upon recognition of a team members (nurses, manner with family and health message to the audience, health care team and family about goals and discernment. patient’s deterioration, family members, etc.) care team purpose, and context in most of care and treatment plan while keeping This schematic depicts development of communicate situation, about patient deterioration situations them up to date clarify patient’s goals of Provides superfluous or proficiency in the Core EPAs. It is not incomplete information to health intended for use as an assessment care, and update family Disregards patient’s goals care team members Actively listens and encourages Actively listens to and elicits feedback instrument. Entrustment decisions members of care or code status idea sharing from the team from team members (e.g., patient, should be made after EPAs have been Does not consider patient’s (including patient and family) nurses, family members) regarding observed in multiple settings with wishes if they differ from those of concerns about patient deterioration to varying context, acuity, and complexity ICS2 ICS6 PPD1 the provider Confirms goals of care and with varying patient determine next steps characteristics.

Laird-Fick, H, Lomis, K, Nelson, A, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. 176 EPA 11: Obtain Informed Consent for Tests and/or Procedures

Behaviors Key Functions with Requiring Expected Behaviors Related Corrective  Developing Behaviors  for an Entrustable An EPA: A unit of Competencies observable, measurable Response (Learner may be at different levels within a row.) Learner professional practice Describe the key Lacks basic Is complacent with informed Lacks specifics when providing Understands and explains From day 1, requiring integration of elements of informed knowledge of the consent due to limited key elements of informed the key elements of informed residents may be in competencies consent intervention understanding of importance consent a position to obtain consent: indications, of informed consent Provides complete and informed consent contraindications, Provides inaccurate Lacks specifics or requires accurate information for interactions, risks, benefits, or misleading Allows personal biases with prompting Recognizes when informed tests, or alternatives, and intervention to influence information consent is needed and procedures they potential complications consent process order and perform, EPA 11 describes it as a matter of of the intervention Hands the patient a good practice rather than as including form and requests a Obtains informed consent an externally imposed immunizations, signature only on the directive of sanction medications, PC6 KP3 KP4 KP5 P6 Obtain others central lines, informed contrast and Communicate with the Uses medical jargon Notices use of jargon and self- Avoids medical jargon radiation consent Uses language that patient and family to frightens patient and corrects Uses bidirectional communication exposures, and Uses unidirectional family to build rapport blood transfusions. ensure that they communication; does not elicit Elicits patient’s preferences by understand the patient’s preferences Practices shared decision making, asking questions intervention Disregards emotional eliciting patient and family cues Has difficulty in attending to preferences Underlying emotional cues Recognizes emotional cues Responds to emotional cues in entrustability for all PC7 ICS1 ICS7 PC5 Regards interpreters real time EPAs are trustworthy Does not consider the use of an Enlists interpreters habits, including as unhelpful or interpreter when needed Enlists interpreters collaboratively truthfulness, inefficient conscientiousness, and discernment. Display an appropriate Displays Displays a lack of confidence Has difficulty articulating Demonstrates confidence balance of confidence overconfidence and that increases patient stress personal limitations such that commensurate with This schematic depicts and skill to put the takes actions that or discomfort, or patient and family will need knowledge and skill so that development of proficiency in the overconfidence that erodes reassurance from a senior patient and family are at Core EPAs. It is not intended for patient and family at can have a negative trust colleague ease use as an assessment instrument. ease, seeking help effect on outcomes Entrustment decisions should be made after EPAs have been when needed Asks questions Asks for help Seeks timely help observed in multiple settings with varying context, acuity, and complexity and with varying patient PPD1 PPD7 PPD8 Accepts help characteristics.

Obeso, V, Biehler, JL, Jokela, JA, Terhune, K, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program 194 Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. EPA 12: Perform General Procedures of a Physician Behaviors Key Functions with Requiring  Developing Behaviors  Expected Behaviors Related Corrective (Learner may be at different levels within a for an Entrustable Competencies An EPA: A unit of Response row.) Learner observable, measurable Demonstrate technical Lacks required Technical skills are variably Approaches procedures as Demonstrates necessary professional practice skills required for the technical skills applied mechanical tasks to be preparation for performance of requiring integration of procedure performed and often initiated procedures Completes the procedure at the request of others competencies Fails to follow sterile • Basic unreliably Correctly performs procedure on PC1 technique when Struggles to adapt approach multiple occasions over time cardiopulmonary indicated Uses universal precautions when indicated resuscitation and aseptic technique Uses universal precautions and (CPR) inconsistently aseptic technique consistently • Bag-mask Does not understand key Describes most of these key Demonstrates and applies ventilation (BMC) Understand and explain Displays lack of the anatomy, issues in performing issues in performing working knowledge of essential • Sterile technique EPA 12 awareness of procedures, such as procedures: indications, anatomy, physiology, indications, • Venipuncture physiology, indications, knowledge gaps indications, contraindications, contraindications, risks, contraindications, risks, benefits, • Insertion of an Perform contraindications, risks, risks, benefits, and benefits, and alternatives and alternatives for each benefits, alternatives, alternatives procedure intravenous line general and potential Demonstrates knowledge of • Placement of a procedures Demonstrates limited common procedural Knows and takes steps to Foley catheter complications of the knowledge of procedural complications but struggles mitigate complications of of a procedure complications or how to to mitigate them procedures physician minimize them PC1 Uses jargon or other Conversations are respectful Demonstrates patient-centered Uses inaccurate ineffective communication and generally free of jargon skills while performing Communicate with the language or presents techniques and elicit patient’s and procedures (avoids jargon, information distorted patient and family to family’s wishes participates in shared decision by personal biases Underlying ensure they understand Does not read emotional making, considers patient’s entrustability for all pre- and post- Disregards patient’s response from the patient When focused on the task emotional response) EPAs are trustworthy procedural activities and family’s wishes during the procedure, may habits, including Does not engage patient in struggle to read emotional Having accounted for the Fails to obtain shared decision making response from the patient patient’s and family’s wishes, truthfulness, PC7 ICS6 P6 conscientiousness, and appropriate consent obtains appropriate informed discernment. before performing a consent procedure This schematic depicts Displays a lack of confidence Asks for help with Seeks timely help development of proficiency in the Demonstrate Displays that increases patient’s complications not stress or discomfort, or Has confidence commensurate Core EPAs. It is intended for confidence that puts overconfidence and use as an assessment instrument. takes actions that overconfidence that erodes with level of knowledge and skill Entrustment decisions should be patients and families at could endanger patient’s trust if the learner that puts patients and families at made after EPAs have been ease patients or providers struggles to perform the ease observed in multiple settings with procedure varying context, acuity, and PPD7 PPD1 complexity and with varying Accepts help when offered patient characteristics.

Amiel, J, Emery M, Hormann, M, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program 212 Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014. EPA 13: Identify System Failures and Contribute to a Culture of Safety and Improvement

An EPA: A unit of Behaviors observable, measurable Requiring  Developing Behaviors  professional practice Key Functions with Related (Learner may be at different levels within Expected Behaviors for an requiring integration of Corrective competencies Competencies Response a row.) Entrustable Learner Identify and report actual and Reports errors in a Superficial understanding Identifies and reports Identifies and reports patient safety potential ("near miss") errors in disrespectful or prevents recognition of real actual and potential concerns in a timely manner using care using system reporting misleading manner or potential errors errors existing system reporting structures structure (e.g., event reporting (e.g., event reporting systems, chain systems, chain of command Demonstrates of command policies) EPA 13 policies) structured approach to describing key elements Speaks up to identify actual and System of patient safety potential errors, even against KP1 ICS2 P4 PPD5 concerns hierarchy Displays frustration at failures Participate in system improvement Passively observes system Participates in system Actively engages in efforts to identify system improvement and activities in the context of rotations improvement activities in the improvement activities systems issues and their solutions efforts or learning experiences (e.g., rapid- context of rotations or when prompted but may culture of cycle change using plan–do–study– learning experiences require others to point safety act cycles, root cause analyses, out system failures morbidity and mortality conference, failure modes and effects analyses, improvement projects) PBLI4 PBLI10 Places self or others at Engage in daily safety habits (e.g., Requires prompts for Demonstrates common Engages in daily safety habits with risk of injury or adverse accurate and complete common safety behaviors safety behaviors only rare lapses event Underlying entrustability documentation, including allergies for all EPAs are and adverse reactions, medicine trustworthy habits, reconciliation, patient education, including truthfulness, universal precautions, hand conscientiousness, and washing, isolation protocols, falls discernment. and other risk assessments, standard prophylaxis, time-outs) This schematic depicts SBP4 development of proficiency in Avoids discussing or Requires prompts to reflect Identifies and reflects Identifies and reflects on the the Core EPAs. It is not Admit one's own errors, reflect on reporting errors; attempts on own errors and their on own contribution to element of personal responsibility for intended for use as an one's contribution, and develop an to cover up errors underlying factors errors but needs help errors assessment instrument. individual improvement plan developing an Entrustment decisions should Demonstrates be made after EPAs have been May not recognize own improvement plan Recognizes causes of lapses, such defensiveness or places fatigue or may be afraid to as fatigue, and modifies behavior or observed in multiple settings P4 SBP5 with varying context, acuity, blame tell supervisor when fatigued seeks help and complexity and with varying patient characteristics.

Crowe, R, Hyderi, A, Rosenfeld, M, Uthman, M, Yingling, S, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program 230 Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.