Entrustable Professional Activities (EPAs)

EPAs are completed using the University of Toronto's Elentra system. Faculty and Residents can login using their UTORid credentials.  For technical assistance, expiration resets, or extensions, please contact Aaron Calano (aaron.calano@utoronto.ca).

EPA General Guidelines

1. Residents and faculty can initiate EPAs. In most cases, residents have been initiating EPAs but faculty are permitted to do so as well. The majority of EPAs can be completed by psychiatry faculty/staff and senior/subspecialty residents. There are a few EPAs that can also be completed by allied health professionals. At least 51% of each EPA must be completed by staff and up to 49% of each EPA can be completed by senior/subspecialty residents or allied health professionals.
2. EPAs are to be initiated within a week of an encounter as they are meant to be brief, low-stakes, “in the moment” assessments. Retroactive submission of EPAs beyond 7 days of the encounter will not be counted. Assessors should be completing these assessments within the week of initiation. Faculty EPA completion rates will be monitored by the program. Residents are discouraged from sending multiple EPAs to a single supervisor (i.e. an EPA “bolus”) for completion.
3. As per July 1, 2022, and UofT PGME guidelines, EPAs expire 14 days after the date of initiation. The program will allow for one additional extension of another 7 days. The duration of completion should be no more than 3 weeks from the date of initiation. Residents/faculty can reach out to Aaron Calano (aaron.calano@utoronto.ca) for an extension.
4. Residents are encouraged to concentrate on EPAs corresponding to their current stage of training. Residents are permitted to reach forward to EPAs in the next stage of training. i.e. a resident in FOD can reach forward and attempt EPAs in COD but should not be attempting TTP EPAs.

Please see our user guide for supervisors below:

Elentra User Guide for Supervisors 

PGME Resources

PGME Elentra Help

What does Entrustment mean?

Tips on assessing EPAs and entrustment levels

2020-21 EPA Entrustment Scale Refinements: Guidance for Assessors

2020-21 EPA Entrustment Scale Refinements: Guidance for Learners

The Psychiatry Competence Subcommittee (PCS) is responsible for looking at whether residents are able to meet the various contextual variables included in the Royal College EPA Guide. Contextual Variables describe the circumstances under which EPA observations occur (e.g. setting, patient complexity). While these variables are tracked in Elentra, they are not currently used as criteria for promotion or progression decisions. The PCS continues to monitor their feasibility and utility.

Refer to "Understanding Contextual Variables" for more information on how to interpret Contextual Variable tracking on Elentra.

View October 2022 Program Director Message - Contexual Variables 

Generally, residents should aim to complete at least 1 EPA a week, and this is how the Psychiatry Competence Subcommittee (PCS) calculates expectations for each PCS review. EPA targets may be adjusted accordingly for each resident due to leaves, redeployment, or other circumstances.

When a resident has completed RCPSC requirements for all EPAs in TTD, FOD and COD (including contextual variables) and they are in PGY4 or beyond, weekly EPA attempts will no longer be a program requirement. Residents at this stage are encouraged to continue EPAs in more complex contexts and with higher complexity patients for ongoing growth and learning. At this stage in residency, residents are expected to be more autonomous in their learning and take responsibility for identifying and addressing any gaps in knowledge or skills. Evidence of greater self-directed learning is demonstrated in self-reflections, coaching sessions, or through professionalism assessment integrated into ITARs

Residents are required to complete entrustments per the Royal College requirements. A summary table is available for download. 

As of July 2026, all Psychiatry training programs will adopt the Royal College of Physicians and Surgeon's Entrustable Professional Activities Psychiatry EPAs 2026 Version 2.0.  The EPAs are available for download and viewing below. 

Download all Royal College EPAs. 

Transition to Discipline

TTD1 OBTAINING A PSYCHIATRIC HISTORY to inform the preliminary diagnostic impression

TTD2 COMMUNICATING CLINICAL ENCOUNTERS in oral and written/electronic form

Foundations of Discipline

FOD1 Assessing and managing patients with NONPSYCHIATRIC CONDITIONS

FOD2 PERFORMING PSYCHIATRIC ASSESSMENTS referencing a biopsychosocial approach, and developing basic differential diagnoses for patients with psychiatric disorders

FOD3 Developing and implementing MANAGEMENT PLANS for patients with uncomplicated presentations

FOD4 Performing RISK ASSESSMENTS that inform the development of an acute safety plan for patients posing risk for harm to self or others

FOD5-A Providing CBT psychotherapy for routine patients: ASSESSING SUITABILITY and establishing the therapeutic relationship in CBT

FOD5-B Providing CBT psychotherapy for routine patients: UTILIZING CBT INTERVENTIONS with entrustability

FOD6 Integrating the FOUNDATIONAL principles and skills of PSYCHOPHARMACOLOGY into patient care

FOD7-A Performing CRITICAL APPRAISAL and presenting psychiatric literature

FOD7-B Performing CRITICAL APPRAISAL and presenting psychiatric literature: PRESENTATION

Core of Discipline

COD1 Performing psychiatric assessment and developing COMPREHENSIVE treatment/management PLANS for adult patients

COD2 Developing comprehensive biopsychosocial FORMULATIONS for patients across the lifespan

COD3 Performing psychiatric assessments and providing differential diagnoses and management plans for CHILDREN AND YOUTH

COD4 Performing psychiatric assessments, and providing differential diagnoses and management plans for OLDER ADULTS

COD5 Identifying, assessing, and managing emergent situations in psychiatric care across the lifespan (EMERGENCIES)

COD6 Applying relevant legislation and LEGAL principles to patient care and clinical practice

COD7 Integrating the principles and skills of PSYCHOPHARMACOLOGY in the assessment and management of patients with challenging presentations and comorbidities

COD8 Delivering PSYCHODYNAMIC, GROUP, AND FAMILY PSYCHOTHERAPIES

COD9 INTEGRATING PSYCHOTHERAPEUTIC INTERVENTIONS into regular patient care

COD10 Managing SUBSTANCE USE DISORDERS for patients with concurrent psychiatric disorders

COD11-A Integrating the principles and skills of neurostimulation into patient care: Suitability for Neurostimulation

COD11-B Integrating the principles and skills of neurostimulation into patient care: Delivery of Neurostimulation

Transition to Practice

TTP1 Managing the clinical and administrative aspects of a psychiatric practice (PRACTICE MANAGEMENT)

TTP2 SUPERVISING junior TRAINEES

TTP3 Providing TEACHING to students, residents, public and other health care professionals

Overview: Psychiatry EPAs by Stage

PGY1

PGY1 Rotation Cards TTD FOD

PGY2

PGY2 Rotation Cards FOD 

PGY3

PGY3 Rotation Cards COD

PGY4

PGY4 Rotations Cards COD 

PGY5

PGY5 Rotation Cards TTP

What is an EPA?

The Royal College defines EPAs as “authentic tasks of a discipline. A supervisor can delegate a task to a resident and observe their performance in the workplace. Over time, frequent observations of a trainee’s performance of an EPA, will provide a comprehensive image of their competence and inform promotion decisions.

What is the purpose of EPAs?

EPAs are workplace-based assessments that provide residents with feedback ‘in the moment’.  Each EPA is intended to serve a formative, developmental purpose for the learner.  Taken together with other assessments, EPAs are reviewed by the Psychiatry Competence Subcommittee to inform holistic decisions about progression and promotion towards independent practice.
 
It may be important here to distinguish between competencies and EPAs. Competencies refer to the abilities of an individual whilst EPAs refer to the work or tasks of a discipline. For a brief explication of the differences, Olle ten Cate provides a cogent overview in the When I say… series in Medical Education: https://onlinelibrary.wiley.com/doi/full/10.1111/medu.14005

What is the entrustment scale and how is this different from the Likert scale on an ITAR/ER?

EPAs are formative assessments (i.e. assessments for learning) rated on an entrustability scale that uses behaviourally anchored criteria to rate the resident’s workplace-based performance on the observed task.  Observers (i.e. faculty supervisors) rate the level of support that was needed to complete the task (e.g. direction, support, competent).  This differs from the Likert scale on ITARs which provide a summative assessment of learning during the course of a rotation aligned with the rotation plan and goals & objectives for each rotation. For a comprehensive list of goals and objectives and rotation plans for rotations please refer to the Rotation Plan Booklet.

Are there different EPAs for each stage of training?

Yes. EPAs are designed to be developmental and are intended to increase in complexity from Transition to Discipline to Transition to Practice.  The Royal College Psychiatry Speciality Committee has created a complexity table that has informed Competence by Design requirements, including EPAs – https://www.royalcollege.ca/rcsite/documents/ibd/psychiatric-complexity-table-e.pdf.

Can residents complete EPAs from a different stage of training?

Residents are encouraged to focus on EPAs from their current stage of training.
 
Residents can reach ahead to EPAs from the next stage.  They cannot, however, complete EPAs from two stages ahead of their current stage.  For example, a resident currently in the Foundations of Discipline (FOD) stage of training should focus on FOD EPAs; however, they may also complete EPAs from Core of Discipline (COD).  They may not complete EPAs in the Transition to Practice (TTP) stage of training. 
 
Residents may complete EPAs from a stage preceding their current stage if it most appropriately reflects the task they are performing.  For example, a senior resident in the Transition to Practice (TTP) stage of training doing a research elective will likely be completing FOD5 (Performing CRITICAL APPRAISAL and presenting psychiatric literature) on this rotation as it is the EPA most relevant to their work in that rotation.

How many EPAs do residents need to complete?

The residency program requires that residents achieve a minimum number of EPA attempts as well as meet Royal College defined EPA targets for all residents who began training on July 1, 2020 or later.
 
Residents are expected to attempt at least one EPA per week.  EPA attempt targets are adjusted for residents due to leaves, redeployment, or other events that may impact on a resident’s capacity to participate in residency training.
Please refer to rotation cards for EPAs that are recommended for both off-service and core and elective/selective psychiatry rotations: https://psychiatry.utoronto.ca/entrustable-professional-activities-epas .

Residents must meet EPA entrustability targets as defined by the Royal College for their stage of training in order to be promoted to the next stage. The Psychiatry Competence Subcommittee, in collaboration with the Program Director, can modify EPA targets if there are extenuating circumstances that affect residents’ capacity to meet the defined targets.
 
Please note that residents who started residency training before July 1, 2020 have different EPA targets as they were not part of the official Royal College launch of CBD for Psychiatry.

If a resident has achieved the EPA targets for their stage of training, do they need to continue to complete EPAs?

Yes, residents are expected to complete at least one EPA per week and to “work ahead” to the next stage. As we welcome our first full cohort of residents entering PGY5 and the Transition to Practice (TTP) stage of training in the 2022-23 academic year, the Assessment Subcommittee and PRPC will have further guidance for our TTP residents as we support a growth mindset and the spirit of continuous improvement in our residency program. If residents or faculty members will like to provide feedback or suggestions about the TTP stage of training, please contact our TTP Curriculum Lead, Michael Mak (michael.mak@camh.ca).
 

Who can assess an EPA?

EPAs may be completed by faculty (staff psychiatrists), health professionals, and senior residents.  Some EPAs indicate specifically who should complete the EPA. For example, COD10 requires direct observation by a psychiatrist.  Overall, >50% of EPAs must be completed by staff psychiatrists.

How and when should EPAs be documented?

EPAs are documented through Elentra and may be triggered by either the resident or their assessors.  Assessors completing an EPA should complete the entrustment scale as well as provide specific and/or actionable qualitative feedback to support resident development. https://psychiatry.utoronto.ca/sites/default/files/inline-files/elentra_how_to_v4_0.pdf
 
EPAs are to be initiated within 7 days of an encounter.  They are meant to be brief, low stakes, “in the moment” assessments.* Retroactive submission of EPAs beyond 7 days of the encounter will not be counted. Assessors should be completing EPAs within 7 days of initiation. Faculty EPA completion rates are monitored by the program. Residents are discouraged from sending multiple EPAs at once (i.e. an EPA “bolus”) for completion.
 
Please note that as per UofT PGME guidelines, EPAs expire 14 days after the date of initiation. The program will allow for one additional extension of another 7 days. The duration of completion should be no more than 2 weeks from the date of initiation. Residents/faculty can contact Aaron Calano (aaron.calano@utoronto.ca) for an additional 7 day extension. 
 
EPAs that were triggered but not completed do not count towards EPA attempt requirements.  It is therefore important that residents trigger and faculty complete EPAs in a timely manner.
 
*For EPAs that involve documentation review in an outpatient clinic setting where it may take more than 7 days to complete and review the documentation, the EPA should be triggered within 7 days of the documentation being ready for the supervisor to review (e.g. after resident review/edits of consult or follow-up note).  

What are contextual variables?  Do they “count”?

Each EPA indicates contextual variables around setting, demographic, case type or complexity and may indicate the number of observations of achievement required for each context.    Although Elentra records and counts contextual variables, we are not currently using contextual variables when adjudicating promotion decisions at PCS.  Nevertheless, some rotations have specific requirements regarding contextual variables for EPA achievement (e.g. Child Psychiatry rotation).

Where can I get more information about EPAs?

• University of Toronto, Department of Psychiatry, Entrustable Professional Activities (EPAs)
  • https://psychiatry.utoronto.ca/entrustable-professional-activities-epas
• Royal College of Physicians and Surgeons of Canada > Standards and Accreditation > Competence by Design
  • https://www.royalcollege.ca/en.html

All general psychiatry training programs will adopt the Royal College 2.0 EPAs as of July 2026. Please refer to this document to learn how we will convert the old EPAs to the new ones.