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Internal Medicine End of Training EPAs

At the 2012 APDIM Spring Conference, the AAIM Education Redesign Committee proposed a draft set of entrustable professional activities (EPAs) to help program directors achieve the goals of competency-based medical education. Using feedback provided by members of the AAIM community, the AAIM Education Redesign Committee revised and slightly expanded this list of EPAs to include 16 activities that constitute the core of the profession.

  1. Manage care of patients with acute common diseases across multiple care settings.
  2. Manage care of patients with acute complex diseases across multiple care settings.
  3. Manage care of patients with chronic diseases across multiple care settings.
  4. Provide age-appropriate screening and preventative care.
  5. Resuscitate, stabilize, and care for unstable or critically ill patients.
  6. Provide perioperative assessment and care. 
  7. Provide general internal medicine consultation to nonmedical specialties.
  8. Manage transitions of care.
  9. Facilitate family meetings.
  10. Lead and work within interprofessional health care teams.
  11. Facilitate the learning of patients, families, and members of the interdiscplinary team.
  12. Enhance patient safety.
  13. Improve the quality of health care at both the individual and systems level.
  14. Advocate for individual patients.
  15. Demonstrate personal habits of lifelong learning.
  16. Demonstrate professional behavior.

These EPAs are written from the perspective of a resident who is ready to enter into unsupervised practice. Accordingly, they are not intended to capture every entrustment decision that occurs over the course of residency training. To present a manageable list and allow flexibility in how programs assess resident competence, some of these EPAs are intentionally broad.

Moving forward, program directors and other groups within and external to AAIM may wish to develop series of discrete EPAs that, in aggregate, inform a more broadly defined end of training EPA. For example, a program may elect to take end of training EPA #8 Manage transitions of care and define component EPAs such as "develop safe discharge plan" or "ensure safe handoffs between caregivers" that inform the broader end of training EPA. Programs may also wish to apply these EPAs to existing developmental assessment frameworks such as reporters, interpreters, managers, and educators (RIME) or learner-manager-teacher (LMT). In summary, these EPAs are intended to act as a starting point or guide for program directors in developing meaningful assessments that inform the evaluation of resident competence and ultimately inform educational milestones reporting in the Next Accreditation System.

To further assist program directors in building meaningful assessments and incorporating the End of Training EPAs into residency training, the AAIM Education Redesign Committee has mapped the curricular milestones directly to these EPAs and provided a three step process for building milestones-based assessments.