Development of Entrustable Professional Activities for Core Diagnostic Radiology Procedures: An APDIR Workgroup Initiative

Although entrustable professional activities (EPAs) have been adopted across many medical specialties, their use in radiology remains limited, largely to subspecialty areas such as breast imaging. A standardized set of EPAs for procedural training in diagnostic radiology has not been widely available. We sought to develop EPAs for 10 core diagnostic radiology procedures through a structured, consensus-based process, providing programs with a behaviorally anchored framework for assessing procedural competence.

Using a consensus-based, expert-panel approach with iterative refinement, a volunteer panel of nine integrated interventional radiology (IR) residency program directors from nine distinct academic institutions adapted the American Board of Surgery's general surgery EPA framework as a template. Ten core diagnostic radiology procedures, previously identified by a joint task force of the Association of Program Directors in Radiology and the Association of Program Directors in Interventional Radiology, were selected for development. Subject-matter experts drafted an EPA for each, a single author harmonized them, and the full panel reviewed and approved the final versions.

Ten EPAs were developed, one for each of the core diagnostic radiology procedures. Each EPA describes the procedure-specific behaviors expected at each phase of care across four entrustment levels-Limited Participation, Direct Supervision, Indirect Supervision, and Practice-Ready. A completed example is provided in Table 1.

A shared set of procedural EPAs for diagnostic radiology was developed through a structured, consensus-based process built on an established general surgery framework. These EPAs give programs a practical way to assess procedural competence and to support decisions about the level of supervision a resident requires for a given procedure.