JCPSLP Vol 23 No 3

Entrustable professional activities (EPAs) Laura Loftus E ntrustable professional activities (EPAs) were first described by Olle ten Cate in 2005 and have been discussed initially in medical education literature and more recently in dietetics and pharmacy literature (ten Cate & Taylor, 2020), but not yet in the discipline of speech and language pathology (SLP). EPAs are larger units of professional practice that can be fully “entrusted” to a health care student once they have been able to demonstrate competence (ten Cate & Taylor, 2020) with that EPA. An EPA is made up of many competencies. An example from an SLP perspective might be “Assessing clients using standardised assessment tools”. It is clear that for a student to perform this professional activity they need to be able to achieve many competencies such as gaining informed consent, conducting standardised assessments accurately, managing the clinical situation appropriately, scoring the assessment, and finally, providing feedback to the client/ carer. EPAs can only be deemed to be “achieved” in a clinical context when observed by a trained professional (ten Cate & Taylor, 2020). Further, for “entrustment”, a decision cannot be made on observation of the student in one single client encounter but should be observed across multiple encounters in different scenarios. The benefits of EPAs are that students can progressively achieve activities of professional practice throughout their training, thus reducing the pressures on final placements. EPAs also empower learners to set their own goals and self-monitor their own progress (ten Cate & Taylor, 2020). EPAs encourage clinical educators to observe students at intervals throughout their studies, thus providing a more thorough student profile. They are a useful means of identifying skill gaps not just in individuals but also in curricula, leading to quality service provision in the future (Bramley & McKenna, 2021). As no work has been written from the professional viewpoint in SLP, these reviews provide an excellent starting point for discussion on the topic of EPAs in SLP. The first paper (Bramley & McKenna, 2021) is a scoping review focusing on EPAs for entry-level health professions education. The scoping review defines the term “entry level” for the purposes of the paper and the inclusion and exclusion criteria adopted for selection of papers. The paper provides a brief overview of the 30 studies using EPAs and reports clear reasons for their decisions regarding inclusion and exclusion; for example, conference abstracts were not included. Reviewed papers came from the disciplines of medicine, pharmacy, dietetics, and physician assistants. No studies were identified for inclusion from SLP. The authors conclude that the development of EPAs has been driven primarily by the need to define the work of each profession. The review reports that studies have found that EPAs do not replace competency-based education but instead enhance it by focusing on students’ ability to integrate multiple competencies successfully. This approach allows for individualisation of student learning and provides scope for attainment of EPAs in a non-time based manner (Bramley & McKenna, 2021). The review reports that the introduction of EPAs has benefited curricula development ensuring students meet a wide range of important competencies which present in complex health care environments. In

addition, the authors report that EPAs have the potential to assist with tracking students’ progression through their studies, thus identifying students who are at risk. The authors conclude that there is growing interest in EPAs as evidenced by the rise in publications over time and suggest that EPAs are here to stay but do caution that the literature is still in its infancy and many of the studies include low numbers of participants and report only on pilot studies. The second paper (Bramley et al., 2021) looks at the use of e-portfolios to assess EPAs among dietetic students. The article was chosen as it is from a health care background with similar challenges to SLP; for example, where clinical educators are not employed by universities yet assess students in high-stake final year placements. The study adopted a mixed methods approach to evaluate the use of e-portfolios from the perspectives of both students and clinical educators following a 110-day placement. A 24-item quantitative survey was completed as Phase 1 of the study. Only 18% of students and 40% of clinical educators completed this survey. This did not allow for statistical significance to be reached and only descriptive statistics were used. Results should therefore be interpreted with caution. The authors summarise with the suggestion that the introduction of EPAs was positively viewed by students and CEs. The survey was followed with a stakeholder consultation to explore the topic in further detail. Recruitment was lower than expected among the student body with only 4 students volunteering. Twelve clinical educators volunteered. The format adopted for the stakeholder meetings was facilitated discussion. Further detail on the format of these meetings and how the data was analysed is not provided and would be beneficial for readers. Reported findings from the stakeholder consultations were that EPAs were less confusing than competency-based assessments (CBA). The authors note that within their own dietetic community there has been criticism of the CBA model as being confusing and ambiguous which may have impacted findings and acknowledge this criticism influenced their decision to introduce EPAs. Criticism of CBAs is not unique to dietetics and has been reported in other health care literature. Confusing and ambiguous assessments have frequently been cited as a reason for failure to fail of students (Yepes-Rios et al., 2016). While the authors acknowledge the limitations of their study as being a single site study with a limited number of participants, the paper does provide some limited evidence that e-portfolios could be used to assess EPAs. This approach to assessment in a profession such as SLP could provide a platform to capture learning at different points in the student journey. If a non-time based approach was adopted, it could potentially reduce the pressure on students and clinical educators on placements leading to a more student-led approach to learning. In conclusion, EPAs, while in their infancy, are becoming more commonly used in health care education and research is emerging regarding how and why they are being adopted. Introduction to the profession of SLP could provide an exciting new approach to assessing students across the curriculum, informing curriculum development and supporting student SLPs on their journey to becoming competent clinicians. Readers wanting more information on EPAs and how to construct them will find the paper by (Ten Cate & Taylor, 2021) useful. References Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review , 84 (2), 191–215.

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JCPSLP Volume 23, Number 3 2021

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