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About milestones and EPAs

A milestone is an observable marker of someone’s ability along a developmental continuum. Milestones are used for planning and teaching.

An entrustable professional activity (EPA) is a task in the clinical setting that a supervisor can delegate to a resident who has demonstrated sufficient competence. Typically, an EPA integrates multiple milestones.  EPAs are used for overall assessment. They are the tasks that must be accomplished, whereas milestones refer to the individual’s abilities.

What makes Royal College EPAs different?

Royal College EPAs are different from EPAs that are developed and used in other jurisdictions:

  • Our EPAs are units of clinical activity that residents perform throughout each stage of the CBD Competence Continuum — rather than simply at the end of training.
  • Each EPA requires multiple competencies and integrates milestones from across the CanMEDS Roles.
  • Teachers can observe (directly or indirectly) and assess these activities in the workplace.

Milestones and EPAs in teaching and assessment

We anticipate that as disciplines transition to Competence by Design (CBD), educators will use milestones to design educational activities and teach specific abilities. Once the skills and attitudes required to reach the milestones have been taught successfully, educators can assess the achievement of various milestones using an EPA.

If the EPA is successfully performed, then all the skills that make up the various milestones within that EPA have been learned and the trainee has demonstrated his/her overall competence.

The combination of milestones and EPAs will allow educators to examine performance at both the micro level (when needed) and the macro level, providing a truly balanced view of a trainee’s abilities. The connection between milestones and EPA will help make teaching and assessment more practical and manageable for busy supervisors.

Unpack EPAs to identify exact problem areas

If a trainee is struggling with a clinical task (an EPA), the teacher can look at the individual abilities (milestones) to determine where further guidance is needed.

If a trainee is struggling with a clinical task (an EPA), the teacher can look at the individual abilities (milestones) to determine where further guidance is needed.

When milestones are achieved ahead of schedule

If a resident achieves all mandatory milestones weeks or months before the scheduled assessment, he or she can use the extra time to hone skills and further prepare for practice. The resident can be given added responsibility to finesse Transition to Practice competencies. Or, the resident can negotiate with the program director and start working on additional advanced training.

Who is developing the milestones and EPAs?

CanMEDS milestones were written for each CanMEDS Role as part of the CanMEDS 2015.

As each discipline transitions to CBD, its specialty committee, including all program directors of the discipline will use these milestones as the basis for developing its own specialty-specific milestones. Each discipline will also develop EPAs based on the discipline’s context and responsibilities.