Cynthia Abbott¹
Ginette Bourgeois¹, Jolanta Karpinski², Peter Perryman¹, Lyn Sonnenberg¹ and Sofia Valanci-Aroesty¹
1 Royal College of Physicians and Surgeons of Canada
2 University of Ottawa 

Standards for medical practice and education in Canada are written using the CanMEDS framework. CanMEDS organizes competencies in seven Roles that shape physician practice. The Competence-by-Design approach includes assessment in the form of entrustable professional activities (EPAs), tasks that must be accomplished to demonstrate competence. Performance of an EPA requires integration of several competencies to carry out the task. The objective of this project was to understand how the CanMEDS intrinsic Roles’ competencies are represented in specialty disciplines. 

Two investigators independently reviewed EPAs for the CanMEDS intrinsic Roles. The CanMEDS framework was cross-referenced with specialties’ pathway-to-competence document. These were mapped to an intrinsic role and tallied. Surgical, medical, and diagnostic specialty sub-analyses were completed. Mean percentages were calculated by total, group, and stage of training. 

Mean percentages demonstrated that the Communicator Role had the largest representation within EPAs with 53%, followed by Collaborator (47%), Professional (28%), Leader and Scholar (18%), and Health Advocate (13%). Health Advocate Role by discipline specialties had the lowest representation (medical (17%), diagnostic (9%), and surgical (8%)). The highest count of EPAs containing Health Advocate came from Geriatric Medicine and Emergency Medicine with 10 and 8 EPAs. 

EPAs are intended to be brief and distinct tasks that are observable. Proportionally, there is underrepresentation of intrinsic Roles in EPAs, like Health Advocate, across disciplines. This suggests that methods of teaching and assessment other than EPAs may be needed for some of the intrinsic roles. 

There is variability in the integration of CanMEDs roles within EPAs; this may be a true reflection of differences in the practice profile of different disciplines. This variability highlights the need to consider how to incorporate teaching and assessment of intrinsic CanMEDS roles in resident training and may demonstrate an opportunity to revise EPAs to meet this goal 

References (maximum three) 

1. https://www.thoracic.org/professionals/peptda/epa.php
2. https://www.royalcollege.ca/ca/en/canmeds/canmeds-framework.html