The Accreditation Council for Graduate Medical Education (ACGME) strives to advance the quality of resident and fellow training. With its Next Accreditation System (NAS), ACGME emphasizes a focus on practical training outcomes and introduces Entrustable Professional Activities (EPAs). EPAs are observable and measurable tasks (activities) that characterize core physician practice within a given specialty or subspecialty, entrusted to a trainee to perform without direct supervision after he or she has attaineed sufficient specific competence.1

EPAs

  • ​define physician work in a field such as Hospice and Palliative Care Medicine (HPM)
  • require knowledge, skills and attitudes to execute the activity
  • cover one or more ACGME core competencies
  • are time-limited and executable by the trainee
  • offer a framework for future trainee assessments and curriculum improvement
  • may result in increased curricular consistency across fellowship training programs
  • are intended to help clinical supervisors with more pragmatic training approach by defining the field-specific tasks expected of trainees.2

EPA 1. Provide comprehensive pain assessment and management for patients with serious illness

EPA 2. Provide comprehensive non-pain symptom assessment and management for patients with serious illness

EPA 3. Manage palliative care emergencies

EPA 4. Estimate and communicate prognosis to aid medical decision-making

EPA 5. Establish goals of care based on patient and/or family values and specific medical circumstances

EPA 6. Participate as a member or leader of an interdisciplinary team

EPA 7. Prevent and mediate conflict and distress over complex medical decisions

EPA 8. Manage withdrawal of advanced life-sustaining therapies

EPA 9. Care for imminently dying patients and their families

EPA 10. Address requests for hastened death

EPA 11. Support patients and families in the psychosocial domain

EPA 12. Support patients and families in the spiritual and existential domain

EPA 13. Promote self-care and resilience

EPA 14. Facilitate transitions across the HPM continuum of care

EPA 15. Fulfill the role of a hospice medical director

EPA 16. Provide HPM consultation and team support

EPA 17. Promote and teach hospice and palliative care

 

Reporting Milestone

Description

HPM EPAs

PC1

Gathers and synthesizes essential info

1, 2, 4, 5, 10

PC2

Develops comprehensive management plan

1, 2, 3, 6, 7, 9, 11, 12, 15, 16

PC3

Manages with progressive responsibility

1, 2, 4, 5, 8, 16

PC4b

Skill in interpreting non-invasive procedures

16

PC5

Requests and provides consultative care

7

MK1

Possesses clinical knowledge

1, 2, 3, 4, 5, 8, 9, 16

MK2

Knowledge and diagnostic testing & procedures

2

MK3

Scholarship

17

SBP1

Works effectively within inter-professional team

3, 6, 9, 11, 12, 15, 17

SBP2

Recognizes system error/advocates improvement

14, 17

SPB3

Practices cost-efficient care

14

SBP4

Transitions patients within and across systems

14

PBLI1

Monitors practice for improvement

1, 13

PBLI2

Learns and improves via performance audit

17

PBLI3

Learns and improves via feedback

10. 13

PBLI4

Learns and improves at the point of care

17

PROF1

Has professional and respectful interactions

6, 7, 12, 15, 16

PROF2

Accepts responsibility and follow through

3, 6, 13

PROF3

Responds to each patient’s unique needs

4, 5, 7, 8, 9. 10, 11, 12, 14

PROF4

Exhibits integrity & ethical behavior

8, 10, 13

ICS1

Communicates with patients and caregivers

3, 4, 5, 7, 9, 10, 11, 12, 16

ICS2

Communicates with inter-professional teams

6, 8, 11, 15

ICS3

Appropriate completion of health records

14, 15