Entrustable Professional Activities

Entrustable Professional Activities (EPAs) are important work tasks that trainees need to be able to perform with supervision at a distance by the end of Basic Training.

By the end of Basic Training trainees need to be able to perform each EPA with supervision at a distance.

Each of the EPAs:

is an exemplar, discrete task, separable from other tasks, which relates to patient care
can be readily observed and assessed
relates to safe healthcare in the workplace. There are consequences associated to this task that are not easily reversed.

Entrustable Professional Activities for Basic Trainees in Adult Internal Medicine and Paediatrics & Child Health (PDF 1.1MB)

EPA Behaviours

Each EPA includes the behaviours of a trainee who can perform the task with supervision at a distance and examples of behaviours of a trainee who is not yet ready to perform the task with supervision at a distance. The behaviours are categorised according to the domains of the RACP Professional Practice Framework, however each EPA should be performed and assessed as a complete task.

How to browse related content

Some parts of the curriculum standards relate to content in other curriculum standards. For example, in the Medical Expertise behaviours you can access links to related Competency content. View the related content within each of the following domains by clicking the '+' symbol.

EPA 1 - Clinical assessment

Clinically assess patients, incorporating interview, examination, and formulation of a differential diagnosis and management plan

This activity requires the ability to:

obtain histories
examine patients
integrate information from assessments into comprehensive formulations
develop provisional and differential diagnoses and problem lists
discuss findings with patients, families, or carers¹
present findings to colleagues, including senior clinicians
perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments.

¹References to patients in the remainder of this document may include their families or carers.

Behaviours

Each EPA has lists of behaviours. The behaviours help trainees understand how they can improve, and help supervisors to make decisions about whether trainees can be trusted to do the task with supervision at a distance

Ready to perform with supervision at a distance

Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.

The trainee:

takes patient-centred histories using appropriate lay terms and avoiding medical jargon
tailors the history taking and physical examination to the clinical situation and the specific patient encounter
incorporates psychosocial considerations into assessment
identifies and uses alternative sources of information to obtain history when needed, such as family members, carers, and other health professionals and professional bodies
recognises and takes precautions where the patient may be vulnerable, such as issues of child protection, self- harm or elder abuse
performs accurate physical examinations
demonstrates patient-centred examination techniques that respect patient privacy, comfort, and safety
consistently uses a developmentally appropriate approach to the physical examination³
recognises and correctly interprets abnormal findings
filters, prioritises, and synthesises pertinent information to direct the clinical encounter and broad diagnostic categories
formulates appropriate differential diagnoses
seeks to understand the concerns and goals of patients and their families or carers
develops appropriate management plans

³ This behaviour is particularly relevant to Paediatrics & Child Health.

Not yet ready to perform with supervision at a distance

Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.

The trainee may:

gather too little information, or exhaustively gather information following a template regardless of the chief complaint
perform inadequate physical examinations
inadequately alter their approach to the physical examination to meet the developmental level, behavioural needs, or the competency level of patients
develop an overly inclusive list of potential diagnoses

² Trainees not yet ready to perform this activity with supervision at a distance may not yet display behaviours displayed by a trainee ready to perform with supervision at a distance. Therefore, not all of these opposing behaviours are listed here. In the remainder of the document lists in this column capture behaviours supervisors and trainees should be particularly aware of when considering entrustment.

Related competency themes

Ready to perform with supervision at a distance

Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.

The trainee:

anticipates, reads, and responds to verbal and non-verbal cues
demonstrates active listening skills
accurately communicates the situation of patients to colleagues, including senior clinicians

Not yet ready to perform with supervision at a distance

Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.

The trainee may:

inadequately interpret verbal and nonverbal cues
inadequately communicate with patients during the assessment, particularly when explaining the process of physical examination
inadequately engage families or carers in the discussion

Related competency themes

Ready to perform with supervision at a distance

Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.

The trainee:

performs hand hygiene and takes infection control precautions at appropriate moments
documents history, physical examination findings, and synthesis with clarity and completeness
recognises and takes precautions against assault from confused or agitated patients, and ensures appropriate care of patients

Related competency themes

Ready to perform with supervision at a distance

Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.

The trainee:

is respectful of patients’ cultures, and attentive to social determinants of health
displays an understanding of at least the most prevalent cultures in society and an appreciation of their sensitivities
appropriately accesses interpretive or culturally-focused services

Not yet ready to perform with supervision at a distance

Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.

The trainee may:

demonstrate an inadequate awareness of, or difficulty accepting and understanding, the cultures of others

Related competency themes

Ready to perform with supervision at a distance

Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.

The trainee:

demonstrates professional conduct, honesty and integrity
maintains patient privacy and confidentiality
displays respect and sensitivity towards patients
assesses patients’ decision-making capacity
maximises patient autonomy and supports patients’ decision making
identifies patients’ preferences regarding management and assesses the role of families in decision making
identifies the decision maker, including whether a substitute decision maker must be involved

Not yet ready to perform with supervision at a distance

Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.

The trainee may:

display lapses in professional conduct, such as acting disrespectfully or providing inaccurate or incomplete information

Related competency themes

Ready to perform with supervision at a distance

Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.

The trainee:

demonstrates clinical reasoning by gathering focused information relevant to patients’ care and according to the presenting situation
recognises their own limitations and seeks help when required in an appropriate way

Not yet ready to perform with supervision at a distance

Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.

The trainee may:

make intuitive leaps to conclusions that are often unsupported by pattern recognition, data, or evidence
inadequately consult with senior colleagues

Related competency themes

Trainees

Entrustable Professional Activities

Entrustable Professional Activities (EPAs) are important work tasks that trainees need to be able to perform with supervision at a distance by the end of Basic Training.

EPA Behaviours

How to browse related content

EPA 1 - Clinical assessment

Clinically assess patients, incorporating interview, examination, and formulation of a differential diagnosis and management plan

Behaviours

Medical expertise

Communication

Quality and safety

Research

Cultural competence

Ethics and professional behaviour

Judgement and decision making

Related Knowledge Guide

Adult Medicine

Paediatrics & Child Health