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The participants in the EPA course

A world leader in medical education teaches a course at Queen's

Dr. Olle ten Cate is a true world leader in medical education, and earlier this month Queen’s University was fortunate enough to host him as he taught his course “Ins and Outs of Entrustable Professional Activities.”

It would be hard to overstate how exciting it was to have this event at Queen’s. The Entrustable Professional Activity (EPA) is a relatively new concept in medical education, but it is changing the way we think about training doctors. An EPA is a key task of a medical discipline that trainees can be trusted to perform when they have demonstrated sufficient competence. For instance, EPAs can range from essential skills in all disciplines, such as taking a patient’s history, to highly specialized skills like the ability to perform a specific operation.

EPAs are so significant because they are a fundamental aspect of competency-based medical education (CBME).  In CBME, educators use EPAs to gauge a learner’s progress through the curriculum. The more EPAs a trainee is trusted to perform, the further along they are in their progress through their education.

While there is a constantly evolving discussion of EPAs among educational scholars, Dr. ten Cate is the originator of the EPA framework. No one, then, could be a more ideal choice to facilitate a course about how to think about EPAs and incorporate them into medical curricula.

Dr. David Taylor, Associate Professor in the Department of Medicine at Queen’s, served as the course coordinator and site director, and as such played an instrumental role in bringing this course to Queen’s. He also deserves a great deal of credit for making the course such a huge success.

In addition to Dr. ten Cate and Dr. Taylor, three other experts in EPAs helped teach the course: Dr. Jacqueline de Graaf from Radbound University in the Netherlands; Dr. Robert Englander from the University of Minnesota; and Dr. Claire Touchie from the University of Ottawa.

The tremendous appeal that this course holds for medical educators is obvious just from looking at the list of participants. People came from all over North America to learn from Dr. ten Cate and discuss EPAs with other educators who are working on incorporating this framework into their teaching. Two participants came from Mexico, six came from the United States, and one even traveled from the United Kingdom. The other twenty-one participants came from Canada; while some were Queen’s faculty members there were also medical educators from schools across Ontario as well as Nova Scotia, Saskatchewan, Quebec, and Manitoba. There were thirty available seats in the course, and Dr. Taylor and his team had no trouble filling them all.

“We had an absolutely fabulous group of participants come to the EPA course at Queen’s,” Dr. Taylor said. “An engaged group always makes teaching easy. And with our faculty team of Olle, Bob, Claire and Jacquie, it really was a world class course. I believe we were able to send out a group of leaders with a rich understanding of EPAs, prepared to advance CBME in their own settings.”

My schedule didn’t allow me to sit in on the whole course, but I did make a point to stop by one afternoon. Unsurprisingly, I was impressed by the intelligence and insight of Dr. ten Cate as he led the group. But I was also excited to see how collegial and energetic the group of participants was.

It was a real pleasure to see them share their experiences with and ideas about EPAs with each other. Enthusiastically, they discussed their understanding of concepts such as Nested EPAs and entrustment decisions and even what constitutes trust in medical education in the first place.

These kinds of conversations are essential for those of us in academic medicine working to embed the EPA framework into our training programs. Open dialogue is how we all learn from each other, create knowledge, and develop a set of best practices for teaching. And, during “Ins and Outs of Entrustable Professional Activities,” the participants were all having this necessary open dialogue and filled it with sharp insights and intellectual generosity.

I also think it was particularly fitting that all this terrific discussion of EPAs went on at Queen’s, where we’ve been leaders in working the EPA framework into our medical education programs. As we launched competency-based medical education (CBME) across all of our postgraduate programs, we put a lot of thought and effort into figuring out how best to incorporate EPAs into our curricula, as they are part of the backbone of CBME.

When I asked Dr. Taylor why he thought that Queen’s would make a good host for this course, it became clear that we had some similar thoughts. “Over the past few years,” he said, “Queen’s has not only shown that it punches far above its weight in medical education, we have established ourselves as the national leaders in CBME. It only made sense to bring the first North American edition the course to Queen’s. Olle ten Cate was more than happy to support this.”

Do you have any thoughts about how you’ve been incorporating EPAs or any other new educational framework into your teaching? If so, let me know in the comments below. Or better yet, please stop by the Macklem House: my door is always open.




Thank you to Andrew Willson for his assistance in preparing this blog.


Rhona Anderson

Sat, 04/27/2019 - 15:11

Dean Reznick,
I am so pleased to see this week's post about medical education and Dr. ten Cate. I hope to hear that he will return to Queen's to share some of his knowledge and research about health professions education, particularly in the clinical environment. There is no doubt that Queen's University is leading in competency-based medical education, and I am very fortunate to hear my education leader (Dr. Brian Hodges, UHN--also a Queen's graduate) speak about it in my workplace. Queen's is also leading with regards to health professions leadership through the innovative Doctor of Science in Rehabilitation and Health Leadership program, and I believe that having speakers address health professions education more broadly would attract many learners too! Thank you for leading such a great team in the Faculty of Health Sciences.
Best regards,

Rhona Anderson

Dear Rhona, 

Thank you very much for your kind words and encouragement. And I will certainly keep your thoughts in mind about making sure we have speakers on campus who address all areas of health professions education. 

All the best,

Richard Reznick

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