Thomas Gale¹
Richard Hankins², Leigh Wilson² and Manda Gillard²
1 Peninsula Medical School
2 General Medical Council, UK

Background
EPAs guide learners and clinical educators in establishing a graded increase in autonomy and responsibility towards performing key tasks of the profession.(1) Although EPAs have been implemented widely across the healthcare professions there is limited use within the context of regulation or licensing assessments despite them being promoted for bridging the capability – competency chasm which exists between the skills that graduates possess and those required by employers.(2) Since July 2019 the General Medical Council has developed plans for the regulation of Anaesthesia Associates (AAs) in the UK. The Anaesthesia Associate Registration Assessment (AARA) has been designed to include the use of EPAs for summative assessment of job activities required of newly qualified AAs. 

Summary of work
A development group of key stakeholders involved with training, supervision and setting standards for Anaesthesia Associates used iterative processes, including 2 national surveys, to gain national consensus for the new AA curriculum, content map and method of assessment for registration. 

Results
164 participants responded to the surveys, representing AAs, anaesthetists, physician associates, students, education providers, medical schools, postgraduate medical institutions, NHS organisations and arms-length bodies. 

Capabilities from the content map were mapped to the AARA which comprises: 

Discussion and conclusions
Student AAs spend the majority of their training time in the workplace as an apprenticeship, with extensive clinical exposure and access to patients. We have established consensus on defined entrustment levels for five EPAs required to qualify as an AA which are achievable across multiple higher education providers in the UK. Using EPAs provides greater authenticity than a simulated OSCE for a national registration assessment but future research is required to establish validity compared to other assessments. 

References (maximum three) 

Rahizan Zainuldin¹
Edwina Rigby^1,2 and Peck Hoon Ong¹
1 Singapore Institute of Technology
2 Health Consulting Asia Pacific

Background 
Despite its growing use in other healthcare professions education, little is known about implementing Entrustable Professional Activities (EPAs) in undergraduate physiotherapy curricula. Using the OTTAWA Consensus framework for good assessments, the use of EPAs was evaluated with the extant Competency and Clinical Reasoning Assessment (CCRA) as a system of assessments in Singapore's undergraduate physiotherapy clinical practice education (CPE). 

Methods 
A deductive qualitative study evaluated the second cycle of EPA implementation. Focus group discussions (FGDs) used semi-structured interviews, guided by the seven OTTAWA criteria of good system of assessments and by the first EPA implementation cycle survey responses. Three final-year physiotherapy student groups and four clinical educators (CEs) groups from various clinical domains and practice settings were held (total 16 students and 16 CEs). Thematic analysis was performed. 

Results 
Seven themes emerged: (1) good understanding of entrustment as readiness for practice with indirect supervision (Purpose-driven); (2) indirect supervision appropriate end entrustment level for students’ training (Acceptable); (3) CEs' ambivalence accepting entrustment level as readiness for practice (Acceptable, Continuous); (4) acknowledgement of complementarity of EPAs with the CCRA but perception of overlap and additional work render EPA assessment unwarranted (Coherence, Feasible); (5) variation and subjectivity of CEs’ decision to reduce supervision (Transparent and free from bias); (6) variations in the use and execution of the tool (Transparent and free from bias); (7) revised form is practical for CEs (Feasible). 

Conclusion 
The use of EPAs in this context was found to be purpose-driven and feasible. EPAs and CCRA were somewhat coherent for the purposes of CPE assessments. Students and CEs preferred EPAs as learning tools. More work is needed to improve the use of EPAs as an assessment by 

improving acceptability and stakeholder’s understanding of the use and execution of the tool, including clearer points-of-prompts for CEs to reduce supervision. 

References (maximum three)