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EPAs and Milestones

Competence by Design (CBD) breaks training down into several different stages. Each stage has its own entrustable professional activities (EPAs) and milestones.

A milestone is an observable marker of an individual's ability along a developmental continuum. An EPA is a task of the discipline. It can be delegated to a resident and observed by a supervisor. Typically, each EPA integrates multiple milestones as we use multiple abilities simultaneously when performing professional activities (e.g. we use our medical expertise, but also our communication skills).

EPAs and milestones can be used as a clear learning path for residents and clear teaching and assessment goals for educators. Learn more about EPAs and milestones in teaching and assessment.

Entrustable Professional Activities

EPAs are authentic tasks of a discipline. A supervisor can delegate a task to a resident and observe their performance in the workplace. Overtime, frequent observations of a trainee’s performance of an EPA, will provide a comprehensive image of their competence and inform promotion decisions.

Royal College EPAs are related to each stage of training (transition to discipline, foundations of discipline, core of discipline, transition to practice). EPAs are designed to be developmental — they go from smaller tasks to bigger tasks as trainees progress through stages of training. Each EPA integrates a number of milestones from different CanMEDS roles; a bigger task may include more milestones and/or more complex milestones.

The process of defining a series of EPAs at each stage provides residents with a clear understanding of the expectations at that stage. EPAs focus the supervisor on stage appropriate expectations, which helps supervisors pinpoint a learner’s achievements and areas for improvement. EPAs are also part of competence committee discussions about resident performance.

Each specialty or subspecialty carefully defines EPA’s that are best suited to ensure their residents progress through training appropriately. The number of EPAs for a specialty is determined by the specialty committee.


Milestones provide learners and supervisors with discrete information about the relevant skills of the discipline. Milestones that have been linked to an EPA are the individual skills that are needed to perform that task. For the purposes of learning and improvement, a resident and supervisor can focus on the EPA as a whole, or examine the milestones linked to that EPA. Over time, this detail is needed to help guide feedback and coaching for improvement.

Milestones allow you as an observer to pinpoint areas that trainees need to improve, in order for them to successfully and reliably complete the EPA.

EPAs and milestones