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 4 - Prescribing
Prescribe medications tailored to patients’ needs and conditions
This activity requires the ability to:
- take and interpret medication histories
- choose appropriate medications4
- communicate with patients about the benefits and risks to patients, and provide instruction on medication administration effects and side effects
- produce prescriptions
- monitor medications for efficacy, safety, and concordance
- review medications and interactions, and cease where appropriate
- perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments
4 Includes drugs, fluids, and oxygen.
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
Medical expertise
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 an awareness of potential side-effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
- appropriately, safely, and accurately selects medications, and demonstrates an understanding of the rationale, risk-benefit, side effects, contraindications, dosage, and drug interactions
- appropriately chooses when not to prescribe medication
- prescribes medication therapies within jurisdictional guidelines on medication management
- refers prescriptions for cytotoxic medications, medications requiring consultant prescription, and known teratogenic medications to consultants
- monitors and adjusts medications
- identifies and manages adverse events
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 understanding of the compatibility of medications with intravenous fluids or the need for medication monitoring
- only complete the basics of an inpatient medication chart such as date, name, and signature
- demonstrate an inadequate understanding of the rationale behind the choice of medication
- be unable to source suitable dosing guidelines or implement dose modifications based on organ function, patient age, or size
Related competency themes
Communication
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:
- explains the rationale for and discusses various treatment options with patients
- explains the benefits and burdens of therapies in light of patients’ individual circumstances
- writes clearly legible scripts or charts using generic names of the required medication in full, including mg/kg/dose information and all legally required information for inpatient and outpatient prescribing
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:
- not adequately discuss appropriate alternatives that may be more acceptable to patients
Related competency themes
Quality and safety
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:
- applies knowledge of the importance of careful dosing; particularly the need for weight and body surface area-based prescribing in children, practical dosing, and not exceeding adult maximum dosage3
- always checks the dose before prescribing
- applies information regarding side effects and monitoring requirements of medications
- identifies medication errors and institutes appropriate measures
- uses electronic prescribing systems safely
- rationalises medications to avoid polypharmacy
- demonstrates understanding of the role of therapeutic drug monitoring
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.
This trainee may:
- display inadequate knowledge of the monitoring requirements or potential side-effects of the medications they are prescribing
- prescribe medications outside a therapeutic relationship
Related competency themes
Teaching and learning
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:
- ensures patients understand the management plan including adherence issues, follow up and monitoring for side-effects, and the practical aspects of administration
- undertakes continuing professional development to maintain currency with prescribing guidelines
Related competency themes
Research
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:
- makes therapeutic decisions according to best evidence, and recognises where evidence is limited, compromised, or subject to bias or conflict of interest
- refers to guidelines to ensure decision making is evidence-based and applies guidelines to individual patients appropriately
Related competency themes
Cultural competence
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:
- appreciates patients’ cultural and religious background, attitude and beliefs, and how these might influence the acceptability of pharmacological and non-pharmacological management approaches
Related competency themes
Ethics and professional behaviour
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 consideration of the utility of medicines in treating illness in their prescribing decisions, including the relative merits of different pharmacological and non-pharmacological approaches
- demonstrates an understanding of the regulatory and legal requirements and limitations regarding prescribing
- reports adverse events related to medications
- demonstrates an understanding of the ethical implications of pharmaceutical industry marketing and funded research
Related competency themes
Judgement and decision making
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 into account the following factors for all medications:
- contraindications
- cost to patients, families, and the community
- funding and regulatory considerations
- generic versus brand medicines
- interactions
- risk–benefit analysis
- 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:
- inadequately consult with senior colleagues
Related competency themes
Leadership, management and teamwork
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:
- works collaboratively with pharmacists
- participates in medication safety meetings and morbidity and mortality meetings
- develops local and national guidelines
Related competency themes
Health policy, systems and advocacy
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:
- incorporates the population-based impacts of, and constraints on, decisions about prescribing, including:
- economic costs to community
- antimicrobial resistance
- applies the principles of prescribing using therapeutic guidelines and other resources
- prescribes in accordance with institutional policies
Related competency themes
Related Knowledge Guide
Adult Medicine
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Cardiology - Key presentations and conditions
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Cardiology - Less common or more complex presentations and conditions
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Cardiology - Epidemiology, pathophysiology and clinical sciences
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Dermatology - Key presentations and conditions
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Dermatology - Less common or more complex presentations and conditions
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Dermatology - Epidemiology, pathophysiology and clinical sciences
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Endocrinology - Key presentation and conditions
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Endocrinology - Less common or more complex presentation and conditions
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Endocrinology - Epidemiology, pathophysiology and clinical sciences
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Endocrinology - Important specific issues
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Gastroenterology - Key presentations and conditions
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Gastroenterology - Less common or more complex presentations and conditions
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Gastroenterology - Epidemiology, pathphysiology and clinical sciences
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Gastroenterology - Important specific issues
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General Medicine - Key presentations and conditions
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General Medicine - Less common or more complex presentations and conditions
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General Medicine - Epidemiology, pathophysiology and clinical sciences
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General Medicine - Important specific issues
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Genetic and Metabolic Medicine - Key presentations and conditions
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Genetic and Metabolic Medicine - Less common or more complex presentations and conditions
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Genetic and Metabolic Medicine - Epidemiology, pathophysiology and clinical sciences
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Geriatric Medicine - Key presentations and conditions
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Geriatric Medicine - Less common or more complex presentations and conditions
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Geriatric Medicine - Epidemiology, pathophysiology and clinical sciences
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Geriatric Medicine - Important specific issues
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Haematology - Key presentations and conditions
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Haematology - Less common or more complex presentations and conditions
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Haematology - Epidemiology, pathophysiology and clinical sciences
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Haematology - Important specific issues
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Immunology & Allergy - Key presentations and conditions
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Immunology & Allergy - Less common or more complex presentations and conditions
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Immunology & Allergy - Epidemiology, pathophysiology and clinical sciences
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Infectious Diseases - Key presentations and conditions
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Infectious Diseases - Less common or more complex presentations and conditions
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Infectious Diseases - Epidemiology, pathophysiology and clinical sciences
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Infectious Diseases - Important specific issues
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Medical Obstetrics - Key presentations and conditions
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Medical Obstetrics - Less common or more complex presentations or conditions
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Medical Obstetrics - Epidemiology, pathophysiology and clinical sciences
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Medical Oncology - Key presentations and conditions
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Medical Oncology - Less common or more complex presentations and conditions
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Medical Oncology - Epidemiology, pathophysiology and clinical sciences
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Nephrology - Key presentations and conditions
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Nephrology - Less common or more complex presentations and conditions
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Nephrology - Epidemiology, pathophysiology and clinical sciences
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Nephrology - Important specific issues
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Neurology - Key presentations and conditions
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Neurology - Less common or more complex presentations and conditions
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Neurology - Epidemiology, pathophysiology and clinical sciences
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Palliative Medicine - Key presentations and conditions
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Palliative Medicine - Less common or more complex presentations and conditions
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Palliative Medicine - Epidemiology, pathophysiology and clinical sciences
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Pharmacology, Toxicology and Addiction Medicine - Key presentations and conditions
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Pharmacology, Toxicology and Addiction Medicine - Less common or more complex presentations and conditions
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Pharmacology, Toxicology and Addiction Medicine - Epidemiology, pathophysiology and clinical sciences
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Pharmacology, Toxicology and Addiction Medicine - Investigations, procedures and clinical assessment tools
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Pharmacology, Toxicology and Addiction Medicine - Important specific issues
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Respiratory and Sleep Medicine - Key presentations and conditions
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Respiratory and Sleep Medicine - Less common or more complex presentations and conditions
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Respiratory and Sleep Medicine - Epidemiology, pathophysiology and clinical sciences
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Rheumatology - Key presentations and conditions
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Rheumatology - Less common or more complex presentations and conditions
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Rheumatology - Epidemiology, pathophysiology and clinical sciences
Paediatrics & Child Health
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Adolescent and Young Adult Medicine - Key presentations and conditions
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Adolescent and Young Adult Medicine - Less common or more complex presentations and conditions
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Adolescent and Young Adult Medicine - Epidemiology, pathophysiology and clinical sciences
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Adolescent and Young Adult Medicine - Important specific issues
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Cardiology - Key presentations and conditions
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Cardiology - Less common or more complex presentations and conditions
-
Cardiology - Epidemiology, pathophysiology and clinical sciences
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Cardiology - Investigations, procedures and clinical assessment tools
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Clinical Sciences - Epidemiology, pathophysiology and clinical sciences
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Clinical Sciences - Important specific issues
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Dermatology - Key presentations and conditions
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Dermatology - Less common or more complex presentations and conditions
-
Dermatology - Epidemiology, pathophysiology and clinical sciences
-
Emergency Medicine - Key presentations and conditions
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Emergency Medicine - Less common or more complex presentations and conditions
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Emergency Medicine - Epidemiology, pathophysiology and clinical sciences
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Emergency Medicine - Important specific issues
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Endocrinology - Key presentations and conditions
-
Endocrinology - Less common or more complex presentations and conditions
-
Endocrinology - Epidemiology, pathophysiology and clinical sciences
-
Endocrinology - Important specific issues
-
Gastroenterology - Key presentations and conditions
-
Gastroenterology - Less common and more complex presentations and conditions
-
Gastroenterology - Epidemiology, pathophysiology and clinical sciences
-
Gastroenterology - Important specific issues
-
General and Community Paediatrics - Key presentations and conditions
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General and Community Paediatrics - Less common or more complex presentations and conditions
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General and Community Paediatrics - Epidemiology, pathophysiology and clinical sciences
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General and Community Paediatrics - Important specific issues
-
Genetic and Metabolic Medicine - Key presentations and conditions
-
Genetic and Metabolic Medicine - Less common or more complex presentations and conditions
-
Genetic and Metabolic Medicine - Epidemiology, pathophysiology and clinical sciences
-
Haematology and Oncology - Key presentations and conditions
-
Haematology and Oncology - Less common or more complex presentations and conditions
-
Haematology and Oncology - Epidemiology, pathophysiology and clinical sciences
-
Immunology and Allergy - Key presentations and conditions
-
Immunology and Allergy - Less common or more complex presentations and conditions
-
Immunology and Allergy - Epidemiology, pathophysiology and clinical sciences
-
Immunology and Allergy - Important specific issues
-
Infectious Diseases - Key presentations and conditions
-
Infectious Diseases - Less common or more complex presentations and conditions
-
Infectious Diseases - Epidemiology, pathophysiology and clinical sciences
-
Infectious Diseases - Important specific issues
-
Neonatal and Perinatal Medicine - Key presentations and conditions
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Neonatal and Perinatal Medicine - Less common or more complex presentations and conditions
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Neonatal and Perinatal Medicine - Epidemiology, pathophysiology and clinical sciences
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Neonatal and Perinatal Medicine - Important specific issues
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Nephrology and Urology - Key presentations and conditions
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Nephrology and Urology - Less common or more complex presentations and conditions
-
Nephrology and Urology - Epidemiology, pathophysiology and clinical sciences
-
Nephrology and Urology - Important specific issues
-
Neurology - Key presentations and conditions
-
Neurology - Less common or more complex presentations and conditions
-
Neurology - Epidemiology, pathophysiology and clinical sciences
-
Respiratory and Sleep Medicine - Key presentations and conditions
-
Respiratory and Sleep Medicine - Less common or more complex presentations and conditions
-
Respiratory and Sleep Medicine - Epidemiology, pathophysiology and clinical sciences
-
Rheumatology - Key presentations and conditions
-
Rheumatology - Less common or more complex presentations and conditions
-
Rheumatology - Epidemiology, pathophysiology and clinical sciences