Entrustable Professional Activities (EPAs) are helping training programmes worldwide assess what truly matters: the ability to manage real emergency patients independently.

 

Author: Dr David Teng

 

 

 

Introduction

Emergency Medicine is, by nature, a specialty defined by action. We resuscitate, manage patients with a broad variety of undifferentiated presentations, decide, lead, teach, and adapt—often simultaneously, and always under uncertainty. Yet for decades, our training and assessment systems have struggled to capture this reality in a coherent way.

Enter Entrustable Professional Activities (EPAs).

EPAs are rapidly becoming a cornerstone of competency-based medical education because they shift the focus from abstract abilities to real clinical work. Instead of asking, “Is this trainee competent in airway management, communication, and clinical reasoning?”, EPAs ask a far more practical question:

“Can I trust this doctor to manage this emergency patient independently?”

 

What Are EPAs in Practical Emergency Medicine Terms?

An EPA is a unit of professional work that:

• Is observable in day-to-day practice

• Requires integration of multiple competencies

• Can be entrusted to a trainee once sufficient competence is demonstrated

In Emergency Medicine, this maps naturally to what we already do. For example:

• Running a resuscitation

• Managing an undifferentiated patient in the Emergency Department

• Leading a shift with multiple simultaneous patients

Each of these tasks blends medical expertise, decision-making, communication, leadership, and professionalism into a single, meaningful clinical activity.

 

A Global Emergency Medicine Perspective: The IFEM Core EPAs

A recent paper in the International Journal of Emergency Medicine describes an International Federation for Emergency Medicine (IFEM) initiative to define a small set of core EPAs for Emergency Medicine specialists worldwide. The Education Practice Group (formerly the Core Curriculum & Education committee) led a nominal group methodology and quality review to determine five core EPAs that define what it means to function as an independent Emergency Physician:

1. Managing patient resuscitation

2. Managing adult and/or paediatric non-resuscitative emergency care

3. Managing multiple emergency patients simultaneously

4. Maintaining quality and safety in emergency care

5. Teaching and supervising emergency care staff

 

Rather than being a long checklist, these five EPAs describe the essence of Emergency Medicine practice, across systems, countries, and resource settings.

Importantly, each EPA was mapped to the IFEM core curriculum and evaluated using a formal quality rubric, ensuring they are:

•  Clearly described
•  Observable in practice
•  Suitable for entrustment decisions
•  Educationally meaningful

Why This Matters for Emergency Medicine Training and Assessment

These EPAs describe what we actually do on shift—not artificial exam constructs. They integrate clinical care, prioritisation, leadership, and systems thinking in a way that mirrors real practice. They also support better entrustment decisions. Instead of signing off isolated skills, supervisors can make holistic judgments such as:

“I trust this registrar to run a resus independently.”

“I trust this resident to manage the department with indirect supervision.”

This is much closer to how we already think about readiness for practice.

From the IFEM perspective, this important piece of work also creates a shared international language. With a globally agreed core set of Emergency Medicine EPAs, training programs can:

• Align expectations

• Benchmark outcomes

• Support mobility and mutual recognition across systems

Entrustment is not just an educational decision—it is a patient safety decision. EPAs make that link explicit and defensible.

 

What’s Next?

For training programs, this work provides:

• A conceptual framework for structuring curricula and assessment

• A practical scaffold for workplace-based entrustment decisions

• A shared vision of what defines an independent Emergency Physician

The real work now lies in:

• Translating these EPAs into local assessment systems

• Faculty development to support high-quality entrustment decisions

• Ensuring EPAs enhance learning rather than becoming another tick-box exercise

 

In Summary

Entrustable Professional Activities offer Emergency Medicine a powerful way to:

• Align training with real clinical work

• Improve assessment authenticity

• Make readiness for independent practice explicit, defensible, and patient-centred

The IFEM core Emergency Medicine EPAs mark an important step toward a globally coherent, clinically grounded definition of what it means to be an Emergency Physician.

 

Reference

Teng D, Venkataraman A, Singer A, Chu S, Cevik AA, Tupesis JP, Hassan T, Kwan J.
Entrustable Professional Activities for Emergency Medicine specialists.
International Journal of Emergency Medicine. 2025;18(1):248.
https://doi.org/10.1186/s12245-025-01075-z