EPAs and Milestones

How CBME Works Assessment CBME Benefits The Impact of CBME

Entrustable Professional Activities, or ‘EPAs’, are activities that will ultimately be entrusted to you to carry out during your residency program. They are the overall clinical tasks that must be accomplished. A series of EPAs have been developed for each stage of residency and once you can demonstrate that you’ve gained sufficient competence to successfully complete these tasks, you’ll be promoted to the next level.

Milestones are meaningful markers of progression. They reflect the abilities you need to accomplish a specific task, and many milestones are integrated into each EPA. Milestones have been developed to help teach and prepare residents to achieve the EPA.

To illustrate how these concepts are used, it’s helpful to look at a common clinical responsibility. As a physician, you’ll have to be able to discuss serious news with your patients and their families across many different clinical environments. This is an example of an EPA. It’s a task that you must be able to perform and you’ll be assessed on whether or not you’re able to competently do so.

The milestones help you get there. Milestones link directly to the CanMEDS framework and in the example above, being an effective communicator is especially important. You’ll have to relate to the patient in a way that honours their unique needs; you’ll need to facilitate discussions that are respectful, non-judgmental, and culturally safe; and complex information about the diagnosis and plan of care must be communicated in a clear, compassionate, respectful, and accurate manner.

Rating scales demonstrate how close you are to achieving competence in each EPA.