From theory to practice: making entrustable professional activities come to life in the context of milestones

Entrustable professional activities (EPAs) are gaining traction across the globe as a practical way to teach and assess competencies in the clinical setting. Full-scale implementation, though, has only taken place in obstetrics-gynecology in the Netherlands and in psychiatry in Australia and New Zealand. As with any conceptual framework, implementation in different contexts will require adaptations. For example, implementation in the United States will need to incorporate the Accreditation Council for Graduate Medical Education's competencies and the recently completed milestones for each of the specialties. In this issue, an article by Aylward and colleagues describes the process for implementing a handoff communication EPA, using milestones as the basis for the assessment tool. The explicit linkage of the milestones with the EPA assessment allows a more definitive "picture" of the learner to emerge at each advancing level of performance of the EPA. This "picture" can be shared with those directly observing the learner and thus provides a potential model for a more reliable assessment of learners performing EPAs and perhaps a more consistent approach to entrustment decisions. The authors hope that Aylward and colleagues' article will be one of many that aim to help the medical education community understand how to implement EPAs as a framework for competency demonstration, as educators try to determine what works, under what conditions and in what settings. Only through a committed effort to share lessons learned can the promise of the theory be translated to practice in the field.