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 8 - Procedures
Plan, prepare for, perform, and provide after care for important procedures
This activity requires the ability to:
- select procedures
- work in partnership with patients and their families or carers to make choices that are right for them, including obtaining consent
- set up the equipment, maintaining a sterile field
- perform procedures
- provide after care for patients, and communicate after-care protocols and instructions to patients and medical and nursing staff
- perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments.
For Adult Internal Medicine a trainee’s opportunity to perform procedures is setting dependent. In some cases, other health professionals may perform the procedure, and here Basic Trainees are expected to complete the processes before and after the procedure.
For Paediatrics & Child Health, the exemplar procedure is lumbar puncture. It is a crucial procedure for Basic Trainees in Paediatrics & Child Health, and trainees’ processes before and after completing the lumbar puncture should be applied to other procedures and those procedures observed.
This activity does not include complex procedures that require specialist training or are inappropriate for Basic Trainees.
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:
- identifies and correctly explains the indication for procedures
- confidently and successfully performs procedures
- mitigates the risks and complications of the procedures
- selects appropriate investigations on the samples obtained in diagnostic procedures
- may have complications relating to procedures that they recognise and manage
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:
- lack confidence in performing a procedure and may have previously only seen the procedure being performed
- be able to assist another trainee or the consultant to perform the procedure
- be unable to explain the indications for the procedure
- be unable to communicate the potential complications of procedures to patients
- approach procedures as a mechanical task without understanding of context, such as patient-specific factors, indications, contraindications, risks, benefits, and alternatives
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 procedures clearly to patients, including the reasons for the procedure, potential alternatives to having the procedure, possible risks of having the procedure, and expected post-procedure course, and supports them to make informed choices
- addresses all concerns of patients relating to the procedure
- attends to the procedure and the patients’ emotional response, such as pain, fear, frustration, or anger
- adequately documents procedures in clinical notes, including procedure performed, medications given, aseptic technique, and after care
- provides nursing and medical staff with clear after-care instructions and explains how to recognise possible complications
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 communicate with patients to help them make informed choices about procedures
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:
- sets up all necessary equipment and creates a sterile field
- adequately positions patients ensuring maximal comfort
- consistently uses universal precautions and aseptic technique
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:
- have a poorly managed sterile field
- inconsistently apply skills, resulting in an inability to reliably complete the procedure, such as inconsistent use of universal precautions and aseptic technique
- be unable to recognise and manage complications
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:
- refers to published procedural guidelines prior to undertaking the procedure
- actively seeks feedback on their technique until competent
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:
- refers to evidence-based clinical guidelines relating to procedures
- demonstrates understanding of the limitations of evidence and the challenges of applying research in daily practice
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:
- only performs procedures when suitably qualified or adequately supervised
- speaks up if asked to perform procedures when not suitably trained or adequately supervised
- ensures procedures only follow the provision of appropriate information for patient decision making, such as valid process of consent
- identifies appropriate proxy decision makers when required
- displays confidence commensurate with their knowledge and skill, thus putting patients at ease during the procedure
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:
- 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:
- recommend inappropriate procedures for patients
- attempt to perform a procedure in an unsafe environment
- overestimate their skill, which may result in potential harm to the patient, both physically and psychologically
- 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:
- ensures all relevant team members are aware that procedures are occurring
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:
- perform procedures without informing relevant team members
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:
- performs procedures in accordance with local health guidelines and 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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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Dermatology - Important specific issues
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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Medical Obstetrics - Important specific issues
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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Clinical Sciences - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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Endocrinology - Key presentations and conditions
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Endocrinology - Less common or more complex presentations and conditions
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Endocrinology - Investigations, procedures and clinical assessment tools
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Gastroenterology - Key presentations and conditions
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Gastroenterology - Less common and more complex presentations and conditions
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Gastroenterology - Investigations, procedures and clinical assessment tools
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Gastroenterology - Important specific issues
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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Haematology and Oncology - Key presentations and conditions
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Haematology and Oncology - Less common or more complex presentations and conditions
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Haematology and Oncology - Investigations, procedures and clinical assessment tools
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Haematology and Oncology - Important specific issues
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Immunology and Allergy - Key presentations and conditions
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Immunology and Allergy - Less common or more complex presentations and conditions
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Immunology and Allergy - Investigations, procedures and clinical assessment tools
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Immunology and Allergy - Important specific issues
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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 - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools
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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
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Nephrology and Urology - Investigations, procedures and clinical assessment tools
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Nephrology and Urology - 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 - Investigations, procedures and clinical assessment tools
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Neurology - 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
-
Respiratory and Sleep Medicine - Investigations, procedures and clinical assessment tools
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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 - Investigations, procedures and clinical assessment tools