Creating Entrustable Professional Activities to Assess Internal Medicine Residents in Training: A Mixed-Methods Approach

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Competency-based medical education has not advanced residency training as much as many observers expected. Some medical educators now advocate reorienting competency-based approaches to focus on a resident's ability to do authentic clinical work.


To develop descriptions of clinical work for which internal medicine residents must gain proficiency to deliver meaningful patient care (for example, “Admit and manage a medical inpatient with a new acute problem”).


A modified Delphi process involving clinical experts followed by a conference of educational experts.


The Royal College of Physicians and Surgeons of Canada.


In phase 1 of the project, members of the Specialty Committee for Internal Medicine participated in a modified Delphi process to identify activities in internal medicine that represent the scope of the specialty. In phase 2 of the project, 5 experts who were scholars and leaders in competency-based medical education reviewed the results.


Phase 1 identified important activities, revised descriptions to improve accuracy and avoid overlap, and assigned activities to stages of training. Phase 2 compared proposed activity descriptions with published guidelines for their development and application in medical education.


The project identified 29 activities that qualify as entrustable professional activities. The project also produced a detailed description of each activity and guidelines for using them to assess residents.


These activities reflect the practice patterns of the developers and may not fully represent internal medicine practice in Canada.


Identification of these activities is expected to facilitate modification of training and assessment programs for medical residents so that programs focus less on isolated skills and more on integrated tasks.

Primary Funding Source:

Southeastern Ontario Academic Medical Organization Endowed Scholarship and Education Fund and Queen's University Department of Medicine Innovation Fund.

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