Intrinsic or Invisible? An Audit of CanMEDS Roles in Entrustable Professional Activities.

Area of Science:

• Medical Education
• Competency-Based Medical Education
• CanMEDS Framework

Background:

• Canadian postgraduate medical education has transitioned to a competency-based model.
• This model features new entrustable professional activities (EPAs) and associated milestones.
• The distribution of these milestones across the CanMEDS roles requires examination.

Purpose of the Study:

• To determine how entrustable professional activity (EPA) milestones are distributed across the CanMEDS roles in Canadian postgraduate medical education.
• To assess the balance between the representation of intrinsic CanMEDS roles and the central medical expert role.

Main Methods:

• A document review of EPA guides from 40 Canadian specialties in 2021.
• Analysis of the percentage of milestones formally linked to each CanMEDS role.
• Exploration of differences based on training stage, EPA weighting, and specialty type.

Main Results:

• Approximately half of all EPA milestones were classified under intrinsic roles.
• The health advocate role showed consistently low representation (mean = 2.95%).
• Leader, scholar, and professional roles were concentrated in the final stages of training.

Conclusions:

• While intrinsic roles are generally represented, their distribution and timing may impact teaching and assessment.
• A low prevalence or late emphasis on certain intrinsic roles could hinder their development.
• Further research is needed to optimize milestone distribution for effective role cultivation throughout training.