Entrustable Professional Activities (EPAs)
In CBD, Entrustable Professional Activities (EPAs) are defined by the Royal College 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.” EPA example: Develop and implement a management plan in a patient with a common mental health concern.
EPAs are related to each stage of training (see competency stage graphic here). EPAs are designed to be developmental — they go from smaller tasks to bigger tasks as trainees progress through stages of training. Each EPA integrates a number of milestones from different CanMEDS roles; a bigger task may include more milestones and/or more complex milestones.
The Department of Psychiatry adopted the Royal College's EPAs in July 2020.
- Transition to Discipline (first 1-3 months) has 2 EPAs.
- Foundations of Discipline (end of the Transition to Discipline through to the end of PGY2) has 5 EPAs.
- Core of Discipline (essentially PGY3 and PGY4) has 13 EPAs. Both COD6 and COD7 have two parts.
- Transition to Practice (PGY5) has 6 EPAs. TTP1 has two parts (A, and B) and TTP3 has three parts (A, B, and C).
An overview of the existing EPAs is available here: EPAs Overview. Detailed information regarding specific EPAs can be below in the Royal College EPAs section.
How are EPAs Assessed?
EPAs are completed using the University of Toronto's Elentra system. Faculty and Residents can login using their UTORid and password. If you are experiencing issues logging on, or require help resetting an EPA please contact Tammy Mok (firstname.lastname@example.org).
EPA General Guidelines
- 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 residents or allied health professionals.
- 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.
- 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 Tammy Mok (email@example.com) for an extension.
- 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:
What does Entrustment mean?
Generally, residents should aim to complete at least 1 EPA a week.
The Psychiatry Competence Subcommittee (PCS) calculates EPA expectations based on the above guideline. EPA targets may be adjusted accordingly for each resident due to leaves, redeployment, or other events.
EPA Entrustment requirements will differ depending on when a resident began residency.
Residents who began residency prior to the official RCPSC launch of CBD for psychiatry on July 1, 2020 (2018, 2019 - current PGY4s-5s) need to have 3 entrustments for each EPA unless the RC requirement is less than 3. An overview is available for download.
Residents who began residency from 2020 onwards (current PGY1s-3s) are required to complete entrustments per RC requirements. A summary table is available for download.
As of July 2020, all Psychiatry training programs adopted the Royal College of Physicians and Surgeon's Entrustable Professional Activities. The EPAs are available for download and viewing below.
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, diagnosing and participating in the management of patients with MEDICAL PRESENTATIONS relevant to psychiatry
FOD2 PERFORMING PSYCHIATRIC ASSESSMENTS referencing a biopsychosocial approach, and developing basic differential diagnoses for patients with mental disorders
FOD3 Developing and implementing MANAGEMENT PLANS for patients with presentations of low to medium complexity
FOD4 Performing RISK ASSESSMENTS that inform the development of an acute safety plan for patients posing risk for harm to self or others
FOD5 Performing CRITICAL APPRAISAL and presenting psychiatric literature
Core of Discipline
COD1 Developing COMPREHENSIVE treatment/management PLANS for adult patients
COD2 Performing psychiatric assessments and providing differential diagnoses and management plans for CHILDREN AND YOUTH
COD3 Performing psychiatric assessments, and providing differential diagnoses and management plans for OLDER ADULTS
COD4 Developing comprehensive biopsychosocial FORMULATIONS for patients across the lifespan
COD5 Identifying, assessing, and managing emergent situations in psychiatric care across the lifespan (EMERGENCIES)
COD6-A Integrating the principles and skills of psychotherapy into patient care (PSYCHOTHERAPY MODALITY)
COD6-C Applying and integrating psychosocial skills and principles in general psychiatric care (INTEGRATING PSYCHOTHERAPY SKILLS)
COD7A-B Integrating the principles and skills of NEUROSTIMULATION into patient care
COD8 Integrating the principles and skills of PSYCHOPHARMACOLOGY into patient care
COD9 Applying relevant legislation and LEGAL principles to patient care and clinical practice
COD10 Providing TEACHING to students, residents, public and other health care professionals
Transition to Practice
TTP1-A Managing the clinical and administrative aspects of a psychiatric practice: patient care (PRACTICE MANAGEMENT - PATIENT)
TTP1-B Managing the clinical and administrative aspects of a psychiatric practice: working with the team (PRACTICE MANAGEMENT - TEAM)
TTP3-A Developing and implementing personalized learning experiences geared to career plans or future practice: DEVELOPING A LEARNING PLAN
TTP3-B Developing and implementing personalized learning experiences geared to career plans or future practice: IMPLEMENTING A TRAINING EXPERIENCE
TTP3-C Developing and implementing personalized learning experiences geared to career plans or future practice: REFLECTING ON LEARNING PLAN EFFICACY
EPA Maps and Rotation Cards
Overview: Psychiatry EPAs by Stage