Core Entrustable Professional

Activities for Entering Residency

Core Entrustable Professional Activities for Entering
Residency: Toolkits for the 13 Core EPAs - Abridged

Learn
Serve
Lead

Association of
American Medical Colleges
The Full Toolkit is Available on AAMC’s Website:
Obeso V, Brown D, Aiyer M, Barron B, Bull J, Carter T, Emery M, Gillespie C, Hormann M, Hyderi A, Lupi C, Schwartz M, Uthman M,
Vasilevskis EE, Yingling S, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program. Toolkits for the 13 Core Entrustable
Professional Activities for Entering Residency. Washington, DC: Association of American Medical Colleges; 2017.
aamc.org/initiatives/coreepas/publicationsandpresentations.

Senior Editors
Vivian Obeso, MD, Florida International University
David Brown, MD, Florida International University
Carrie Phillipi, MD, PhD, Oregon Health & Science University

Editors
Meenakshy Aiyer, MD, University of Illinois
Beth Barron, MD, Columbia University
Jan Bull, MA, Association of American Medical Colleges
Teresa J. Carter, EdD, Virginia Commonwealth University
Matthew Emery, MD, MSc, Michigan State University
Colleen Gillespie, PhD, New York University
Mark Hormann, MD, The University of Texas Health Science Center at Houston
Abbas Hyderi, MD, MPH, University of Illinois
Carla Lupi, MD, Florida International University
Michael L. Schwartz, PhD, Yale University
Margaret Uthman, MD, The University of Texas Health Science Center at Houston
Eduard E. Vasilevskis, MD, MPH, Vanderbilt University
Sandra Yingling, PhD, University of Illinois at Chicago

AAMC Staff
Alison Whelan, MD Chris Hanley, MBA Lynn Shaull, MA
Chief Medical Education Officer Project Manager Senior Research Specialist

For inquiries and correspondence, contact Dr. Vivian Obeso at vobeso@fiu.edu, Carrie Phillipi at phillica@ohsu.edu, or Dr. Alison Whelan
at awhelan@aamc.org.

This is a publication of the Association of American Medical Colleges. The AAMC serves and leads the academic medicine community to
improve the health of all. aamc.org

© 2017 Association of American Medical Colleges. May be reproduced and distributed with attribution for educational or
noncommercial purposes only.
User Guide
This toolkit is for medical schools interested in implementing the Core Entrustable Professional Activities (EPAs) for Entering
Residency. Written by the AAMC Core EPA Pilot Group, the toolkit expands on the EPA framework outlined in the EPA
Developer’s Guide (AAMC 2014). The Pilot Group identified progressive sequences of student behavior that medical
educators may encounter as students engage in the medical school curriculum and became proficient in integrating their
clinical skills. These sequences of behavior are articulated for each of the 13 EPAs in one-page schematics to provide a
framework for understanding EPAs; additional resources follow.
This toolkit includes:
• One-page schematic of each EPA
• Core EPA Pilot supervision and coactivity scales

One-Page Schematics
In 2014, the AAMC launched a pilot project with 10 institutions to address the feasibility of implementing 13 EPAs for
entering residency in undergraduate medical education. To standardize our approach as a pilot and promote a shared
mental model, the Core EPA Pilot Group developed one-page schematics for each of the 13 EPAs.

These schematics were developed to translate the rich and detailed content within The Core Entrustable Professional
Activities for Entering Residency Curriculum Developers’ Guide published in 2014 by the AAMC into a one-page, easy-to-use
format (AAMC 2014). These one-page schematics of developmental progression to entrustment provide user-friendly
descriptions of each EPA. We sought fidelity to the original ideas and concepts created by the expert drafting panel that
developed the Core EPA Guide.

We envision the one-page schematics as a resource for:

 Development of curriculum and assessment tools

 Faculty development
 Student understanding
 Entrustment committees, portfolio advisors, and others tracking longitudinal student progress

Understanding the One-Page Schematic

Performance of an EPA requires integration of multiple competencies (Englander and Carraccio 2014). Each EPA schematic
begins with its list of key functions and related competencies. The functions are followed by observable behaviors of
increasing ability describing a medical student’s development toward readiness for indirect supervision. The column
following the functions lists those behaviors requiring immediate correction or remediation. The last column lists expected
behaviors of an entrustable learner.

The members of the Curriculum and Assessment Team of the Core EPA Pilot Group led this initiative. Thirteen EPA groups,
each comprising representatives from four to five institutions, were tasked with creating each EPA schematic. Development
of the schematics involved an explicit, standardized process to reduce variation and ensure consistency with functions,
competencies, and the behaviors explicit in the Core EPA Guide. Behaviors listed were carefully gathered from the Core EPA
Guide and reorganized by function and competency and listed in a developmental progression. The Curriculum and
Assessment Team promoted content validity by carrying out iterative reviews by telephone conference call with the
members of the Core EPA Pilot Group assigned to each EPA.

EPA Curriculum and Assessment

Multiple methods of teaching and assessing EPAs throughout the curriculum will be required to make a summative
entrustment decision about residency readiness. The schematics can help to systematically identify and map curricular
elements required to prepare students to perform EPAs. Specific prerequisite curricula may be needed to develop
knowledge, skills, and attitudes before the learner engages in practice of the EPA.

To implement EPAs, medical schools should identify where in the curriculum EPAs will be taught, practiced, and assessed.
Among other modalities, simulation, reflection, and standardized and structured experiences will all provide data about
student competence. However, central to the concept of entrustment is the global performance of EPAs in authentic clinical
settings, where the EPA is taught and assessed holistically, not as the sum of its parts.

Workplace-Based Assessments: Supervision and Coactivity Scales

On a day-to-day basis, clinical supervisors make and communicate judgments about how much help (coactivity) or
supervision a student or resident needs. “Will I let the student go in the room without me? How much will I let the student
do versus observe? Because I wasn’t present to observe, how much do I need to double-check?” Scales for clinical
supervisors to determine how much help or supervision a student needs for a specific activity have been proposed (Chen et
al 2015; Rekman et al 2016). There is limited validity evidence for these scales, and no published data comparing them.
Given our initial experience, the Core EPA Pilot Group has agreed on a trial using modified versions of these scales (Appendix
1).
EPA 1: Gather a History and Perform a Physical Examination
Key Functions Behaviors  Developing Behaviors  Expected Behaviors for an
with Related Requiring (Learner may be at different levels within a row.) Entrustable Learner
An EPA: A unit of
observable, measurable Competencies Corrective Gathers excessive or incomplete data Uses a logical progression of Obtains a complete and accurate
professional practice Response questioning history in an organized fashion
requiring integration of
Obtain a complete
and accurate history Does not collect Does not deviate from a template
competencies Questions are prioritized and Seeks secondary sources of
in an organized accurate historical not excessive information when appropriate (e.g.
fashion data family, primary care physician,
living facility, pharmacy)
Relies exclusively
PC2 on secondary Adapts to different care settings
sources or and encounters
EPA 1 Demonstrate
documentation of
others
patient-centered Communicates unidirectionally Demonstrates effective Adapts communication skills to the
Gather a interview skills Is disrespectful in
communication skills, including individual patient’s needs and
interactions with Does not respond to patient verbal and
history silence, open-ended characteristics
patients nonverbal cues
and ICS1 ICS7 P1 P3 P5 questions, body language,
listening, and avoids jargon Responds effectively to patient’s
perform a May generalize based on age, gender, verbal and nonverbal cues and
physical Disregards patient culture, race, religion, disabilities, and/or Anticipates and interprets emotions
privacy and sexual orientation patient’s emotions
exam autonomy
Does not consistently consider patient Incorporates responses
privacy and autonomy appropriate to age, gender,
Demonstrate clinical culture, race, religion,
disabilities and/or sexual
Underlying entrustability for reasoning in orientation
all EPAs are trustworthy gathering focused
habits, including information relevant Fails to recognize Questions are not guided by the evidence Questions are purposefully Demonstrates astute clinical
truthfulness, patient’s central and data collected used to clarify patient’s issues reasoning through targeted
conscientiousness, and
to a patient’s care
problem hypothesis-driven questioning
discernment. Does not prioritize or filter information Is able to filter signs and
KP1 symptoms into pertinent Incorporates secondary data into
Questions reflect a narrow differential
Perform a clinically positives and negatives medical reasoning
diagnosis
relevant,
appropriately
This schematic depicts development of thorough physical Does not consider Performs basic exam maneuvers Targets the exam to areas Performs an accurate exam in a
proficiency in the Core EPAs. It is not patient’s privacy correctly necessary for the encounter logical and fluid sequence
intended for use as an assessment
exam pertinent to
and comfort during
instrument. Entrustment decisions the setting and exams Does not perform exam in an organized Identifies and describes Uses the exam to explore and
should be made after EPAs have been purpose of the fashion normal findings prioritize the working differential
observed in multiple settings with varying patient visit Incorrectly performs diagnosis
context, acuity, and complexity and with Relies on head-to-toe examination
basic physical exam Explains exam maneuvers to
varying patient characteristics. Can identify and describe normal
PC2 maneuvers Misses key findings patient
and abnormal findings

Barron B, Orlander P, Schwartz ML. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 2: Prioritize a Differential Diagnosis Following a Clinical Encounter
An EPA: A unit of
observable, measurable
professional practice
requiring integration of
competencies
EPA 2
Prioritize a
differential
diagnosis
Underlying entrustability
for all EPAs are
trustworthy habits,
including truthfulness,
conscientiousness, and
discernment.
This schematic depicts development
of proficiency in the Core EPAs. It is
not intended for use as an
assessment instrument. Entrustment
decisions should be made after EPAs
have been observed in multiple
settings with varying context, acuity,
and complexity and with varying
patient characteristics.
Green M, Tewksbury L, Wagner D. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
Key Functions with
Related Competencies
Synthesize essential
information from previous
records, history, physical
exam, and initial diagnostic
evaluations to propose a
scientifically supported
differential diagnosis
PC2 KP3 KP4 KP2
Prioritize and continue to
integrate information as it
emerges to update
differential diagnosis, while
managing ambiguity
PC4 KP3 KP4 PPD8 PBL1
Engage and communicate
with team members for
endorsement and verification
of the working diagnosis that
will inform management
plans
KP3 KP4 ICS2
Behaviors
Requiring
Corrective
Response
Cannot gather or
synthesize data to
inform an acceptable
diagnosis
Lacks basic medical
knowledge to reason
effectively
Disregards emerging
diagnostic information
Becomes defensive and/or
belligerent when
questioned on differential
diagnosis
Ignores team’s
recommendations
Develops and acts on a
management plan before
receiving team’s
endorsement
Cannot explain or
document clinical
reasoning
 Developing Behaviors 
(Learner may be at different levels within a row.)
Approaches assessment from a rigid
template
Struggles to filter, prioritize, and make
connections between sources of
information
Proposes a differential diagnosis that is
too narrow, is too broad, or contains
inaccuracies
Demonstrates difficulty retrieving
knowledge for effective reasoning
Does not integrate emerging
information to update the differential
diagnosis
Displays discomfort with ambiguity
Recommends a broad range of
untailored diagnostic evaluations
Depends on team for all management
plans
Does not completely explain and
document reasoning
Gathers pertinent data based
on initial diagnostic
hypotheses
Proposes a reasonable
differential diagnosis but may
neglect important diagnostic
information
Is beginning to organize
knowledge by illness scripts
(patterns) to generate and
support a diagnosis
Considers emerging
information but does not
completely integrate to
update the differential
diagnosis
Acknowledges ambiguity and
is open to questions and
challenges
Recommends diagnostic
evaluations tailored to the
evolving differential diagnosis
after having consulted with
team
Explains and documents
clinical reasoning
Expected Behaviors for an
Entrustable Learner
Gathers pertinent information from
many sources in a hypothesis-driven
fashion
Filters, prioritizes, and makes
connections between sources of
information
Proposes a relevant differential
diagnosis that is neither too broad nor
too narrow
Organizes knowledge into illness
scripts (patterns) that generate and
support a diagnosis
Seeks and integrates emerging
information to update the differential
diagnosis
Encourages questions and challenges
from patients and team
Proposes diagnostic and
management plans reflecting team’s
input
Seeks assistance from team
members
Provides complete and succinct
documentation explaining clinical
reasoning
EPA 3: Recommend and Interpret Common Diagnostic and Screening Tests
Key Functions with Behaviors
An EPA: A unit of Related Competencies Requiring
observable, measurable Corrective
professional practice Recommend first-line  Developing Behaviors  Expected Behaviors for an
requiring integration of cost-effective screening Response (Learner may be at different levels within a row.) Entrustable Learner
competencies and diagnostic tests for Unable to recommend Recommends tests for Considers costs Recommends key, reliable, cost-
routine health a standard set of common conditions effective screening and diagnostic
maintenance and screening or diagnostic Identifies guidelines for tests
common disorders tests Does not consider harm, standard tests
costs, guidelines, or Applies patient-specific guidelines
Demonstrates
EPA 3 PC5 PC9 SBP3 PBLI9
KP1 KP4
frustration at cost-
patient resources Repeats diagnostic tests
at intervals that are too
containment efforts Does not consider frequent or too lengthy
patient-specific
screening unless
Diagnostic instructed
and Provide rationale for
screening Recommends Understands pre- and Provides individual rationale based
decision to order tests, unnecessary tests or posttest probability on patient’s preferences,
Cannot provide a
tests taking into account pre- tests with low pretest demographics, and risk factors
rationale for ordering
and posttest probability tests probability Neglects impact of false
and patient preference positive or negative results Incorporates sensitivity, specificity,
Neglects patient’s and prevalence in recommending
preferences Aware of patient’s and interpreting tests
PC5 PC7 KP1 KP4
preferences
SBP3 PBLI9 Explains how results will influence
Underlying diagnosis and evaluation
entrustability for all
EPAs are trustworthy
habits, including
truthfulness,
conscientiousness, Can only interpret Misinterprets Recognizes need for Distinguishes common, insignificant
and discernment. results based on insignificant or assistance to evaluate abnormalities from clinically
normal values from the explainable urgency of results and important findings
Interpret results of basic lab abnormalities communicate these to
This schematic depicts development
studies and understand patient Discerns urgent from nonurgent
of proficiency in the Core EPAs. It is the implication and Does not discern Does not know how to results and responds correctly
not intended for use as an urgency of the results urgent from nonurgent respond to urgent test
assessment instrument. Entrustment results results Seeks help for interpretation of tests
decisions should be made after EPAs PC4 PC5 PC7 KP1 beyond scope of knowledge
have been observed in multiple Requires supervisor to
settings with varying context, acuity, discuss results with
and complexity and with varying patient
patient characteristics.

Biskobing D, Chang L, Thompson-Busch A. Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 4: Enter and Discuss Orders and Prescriptions
An EPA: A unit of
observable, measurable
professional practice
requiring integration of
competencies
EPA 4
Enter and
discuss
orders and
prescriptions
Underlying
entrustability for all
EPAs are trustworthy
habits, including
truthfulness,
conscientiousness,
and discernment.
This schematic depicts
development of proficiency in the
Core EPAs. It is not intended for
use as an assessment instrument.
Entrustment decisions should be
made after EPAs have been
observed in multiple settings with
varying context, acuity, and
complexity and with varying patient
characteristics.
Mejicano G, Ryan M, Vasilevskis EE, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
Key Functions with
Related
Competencies
Compose orders
efficiently and
effectively verbally, on
paper, and electronically
PC6 PBLI1
Demonstrate an
understanding of the
patient’s condition that
underpins the provided
orders
PC5 PC2
Recognize and avoid
errors by attending to
patient-specific factors,
using resources, and
appropriately
responding to safety
alerts
PBLI7
Discuss planned orders
and prescriptions with
team, patients, and
families
ICS1 SBP3
Behaviors
Requiring
Corrective
Response
Unable to compose or
enter electronic orders
or write prescriptions
(or does so for the
wrong patient or using
an incorrect order set)
Does not follow
established protocols
for placing orders
Lacks basic knowledge
needed to guide orders
Demonstrates
defensiveness when
questioned
Discounts information
obtained from
resources designed to
avoid drug–drug
interactions
Fails to adjust doses
when advised to do so
by others
Ignores alerts
Places orders and/or
prescriptions that
directly conflict with
patient’s and family’s
health or cultural beliefs
 Developing Behaviors 
(Learner may be at different levels within a row.)
Does not recognize when to tailor or
deviate from the standard order set
Orders tests excessively (uses shotgun
approach)
May be overconfident, does not seek
review of orders
Has difficulty filtering and synthesizing
information to prioritize diagnostics and
therapies
Unable to articulate the rationale behind
orders
Underuses information that could help
avoid errors
Relies excessively on technology to
highlight drug–drug interactions and/or
risks (e.g., smartphone or EHR suggests
an interaction, but learner cannot explain
relevance)
Places orders without communicating
with others; uses unidirectional style
(“Here is what we are doing...”)
Does not consider cost of orders or
patient’s preferences
Recognizes when to tailor or deviate
from the standard order set
Completes simple orders
Demonstrates working knowledge of
how orders are processed in the
workplace
Asks questions, accepts feedback
Articulates rationale behind orders
May not take into account subtle signs
or exam findings guiding orders
May inconsistently apply safe
prescription-writing habits such as
double-check of patient’s weight, age,
renal function, comorbidities, dose
and/or interval, and pharmacogenetics
when applicable
Modifies plan based on patient’s
preferences
May describe cost-containment efforts
as externally mandated and interfering
with the doctor–patient relationship
Expected Behaviors for an
Entrustable Learner
Routinely recognizes when to tailor
or deviate from the standard order
set
Able to complete complex orders
requiring changes in dose or
frequency over time (e.g., a taper)
Undertakes a reasoned approach to
placing orders (e.g., waits for
contingent results before ordering
more tests)
Recognizes limitations and seeks
helps
Recognizes patterns, takes into
account the patient’s condition
when ordering diagnostics and/or
therapeutics
Explains how test results influence
clinical decision making
Routinely practices safe habits
when writing or entering
prescriptions or orders
Responds to EHR’s safety alerts
and understands rationale for them
Uses electronic resources to fill in
gaps in knowledge to inform safe
order writing (e.g., drug–drug
interactions, treatment guidelines)
Enters orders that reflect
bidirectional communication with
patients, families, and team
Considers the costs of orders and
the patient’s ability and willingness
to proceed with the plan
EPA 5: Document a Clinical Encounter in the Patient Record
Key Functions
with Related
Competencies
An EPA: A unit of
Prioritize and synthesize
observable, measurable
information into a cogent
professional practice narrative for a variety of
requiring integration of
clinical encounters (e.g.,
competencies admission, progress, pre-
and post-op, and
procedure notes;
informed consent;
discharge summary)
P4 ICS1
Behaviors
Requiring
Corrective  Developing Behaviors  Expected Behaviors for an
(Learner may be at different levels within a row.) Entrustable Learner
Response
Misses key information Provides key information but Provides a verifiable cogent narrative
Provides incoherent
may include unnecessary without unnecessary details or
documentation Uses a template with limited ability to
details or redundancies redundancies
adjust or adapt based on audience,
context, or purpose Demonstrates ability to adjust Adjusts and adapts documentation
or adapt to audience, context, based on audience, context, or
or purpose purpose (e.g., admission, progress,
pre- and post-op, and procedure notes;
informed consent; discharge summary)

EPA 5 Follow documentation Copies and pastes Produces documentation that has
errors or does not fulfill institutional
Recognizes and corrects errors
related to required elements of
Provides accurate, legible, timely
documentation that includes
requirements to meet information without
verification or requirements (e.g., date, time, documentation institutionally required elements
regulations and
attribution signature, avoidance of prohibited
Document professional abbreviations) Meets needed turnaround time Documents in the patient’s record role
a clinical expectations for standard documentation
Does not provide in team-care activities
encounter Has difficulty meeting turnaround
ICS5 P4 SBP1 documentation when
expectations, resulting in team May not document the pursuit Documents use of primary and
required
members’ lack of access to of primary or secondary secondary sources necessary to fill in
documentation sources important to the gaps
Provides illegible
Underlying encounter
entrustability for all documentation
EPAs are trustworthy Does not document a problem list, Documents a problem list, Documents a problem list, differential
habits, including Includes
inappropriate differential diagnosis, plan, clinical differential diagnosis, plan, and diagnosis, and plan, reflecting a
truthfulness, combination of thought processes and
judgmental reasoning, or patient’s preferences clinical reasoning
conscientiousness, Document a problem input from other providers
and discernment. list, differential language
Interprets laboratories by relying on Is inconsistent in interpreting
diagnosis, and plan Interprets laboratory values accurately
Documents norms rather than context basic tests accurately
This schematic depicts supported through
development of proficiency in the clinical reasoning that potentially damaging Identifies key problems, documenting
information without Does not include a rationale for Engages in help-seeking
Core EPAs. It is not intended for reflects patient’s engagement of those who can help
attribution ordering studies or treatment plans behavior resulting in improved
use as an assessment instrument. preferences resolve them
ability to develop and document
Entrustment decisions should be Demonstrates limited help-seeking management plans
made after EPAs have been PC4 PC6 ICS1 ICS2 Communicates bidirectionally to
behavior to fill gaps in knowledge, develop and record management plans
observed in multiple settings with skill, and experience Solicits patient’s preferences aligned with patient’s preferences
varying context, acuity, and and records them in a note
complexity and with varying patient
characteristics.

7
Carter TJ, Drusin R, Moeller J, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 6: Provide an Oral Presentation of a Clinical Encounter Behaviors
Requiring  Developing Behaviors  Expected Behaviors for an
An EPA: A unit of Key Functions with Corrective (Learner may be at different levels within a row.) Entrustable Learner
observable, measurable Related Response Gathers evidence incompletely or Acknowledges gaps in Presents personally verified and
professional practice Competencies exhaustively knowledge, adjusts to feedback, accurate information, even when
requiring integration of Fabricates information
competencies Present personally and then obtains additional sensitive
when unable to Fails to verify information information
gathered and verified respond to questions Acknowledges gaps in knowledge,
information, Does not obtain sensitive reflects on areas of uncertainty, and
acknowledging areas of Reacts defensively information seeks additional information to clarify
uncertainty when queried or refine presentation

EPA 6 PC2 PBL1 PPD4 P1

Presents in a Delivers a presentation that is not Delivers a presentation organized Filters, synthesizes, and prioritizes
Provide an disorganized and concise or that wanders around the chief concern information into a concise and well-
incoherent fashion organized presentation
oral Provide an accurate, When asked, can identify
Presents a story that is imprecise
presentation concise, well-organized because of omitted or extraneous pertinent positives and negatives Integrates pertinent positives and
of a clinical information that support hypothesis negatives to support hypothesis
oral presentation
encounter Supports management plans with Provides sound arguments to
ICS2 PC6 limited information support the plan

Presents information Follows a template When prompted, can adjust

Adjust the oral
in a manner that presentation in length and Tailors length and complexity of
presentation to meet Uses acronyms and medical complexity to match situation and presentation to situation and receiver
frightens family
the needs of the jargon receiver of information of information
Underlying entrustability receiver
for all EPAs are
Projects too much or too little Conveys appropriate self-assurance
trustworthy habits,
ICS1 ICS2 PBL1 PPD7 confidence to put patient and family at ease
including truthfulness,
conscientiousness, and
discernment.
Demonstrate respect for Disregards patient’s Lacks situational awareness when Incorporates patient’s preferences Respects patients’ privacy and
This schematic depicts
development of proficiency in the
patient’s privacy and privacy and autonomy presenting sensitive patient and privacy needs confidentiality by demonstrating
autonomy information situational awareness when
Core EPAs. It is not intended for
discussing patients
use as an assessment instrument.
Entrustment decisions should be Does not engage patients and
P3 P1 PPD4 families in discussions of care Engages in shared decision making
made after EPAs have been
observed in multiple settings with by actively soliciting patient’s
varying context, acuity, and preferences
complexity and with varying
patient characteristics.

Catallozzi M, Dunne D, Noble JM, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 7: Form Clinical Questions and Retrieve Evidence to Advance Patient Care
Key Functions with
Behaviors
Related Competencies
Requiring
Combine curiosity, Corrective  Developing Behaviors  Expected Behaviors for an
objectivity, and scientific Response (Learner may be at different levels within a row.) Entrustable Learner
reasoning to develop a Does not With prompting, translates Seeks assistance to translate Identifies limitations and gaps in
An EPA: A unit of
observable, measurable well-formed, focused, reconsider information needs into clinical information needs into well- personal knowledge
professional practice pertinent clinical approach to a questions formed clinical questions
requiring integration of question problem, ask for Develops knowledge guided by
competencies (ASK) help, or seek well-formed clinical questions
new information
KP3 PBLI6 PBLI1 PBLI3
Demonstrate awareness Declines to use Uses vague or inappropriate Employs different search Identifies and uses available
and skill in using new information search strategies, leading to an engines and refines search databases, search engines, and
information technology to
EPA 7 access accurate and
technologies unmanageable volume of
information
strategies to improve efficiency
of evidence retrieval
refined search strategies to acquire
relevant information
reliable medical
information
Clinical
(ACQUIRE)
questions
to advance PBLI6 PBLI7 Refuses to Accepts findings from clinical Judges evidence quality from Uses levels of evidence to
patient consider gaps studies without critical appraisal clinical studies appraise literature and determines
Demonstrate skill in
care and limitations in applicability of evidence
appraising sources,
the literature or With assistance, applies Applies published evidence to
content, and applicability apply published evidence to common medical common medical conditions Seeks guidance in understanding
of evidence evidence to conditions subtleties of evidence
Underlying entrustability
for all EPAs are
(APPRAISE) specific patient
trustworthy habits, care
including truthfulness, PBLI6 KP3 KP4
conscientiousness, and
discernment. Apply findings to Does not discuss Communicates with rigid Applies findings based on Applies nuanced findings by
individuals and/or patient findings with team recitation of findings, using audience needs communicating the level and
medical jargon or displaying consistency of evidence with
This schematic depicts development panels; communicate
Does not personal biases Acknowledges ambiguity of appropriate citation
of proficiency in the Core EPAs. It is findings to the patient determine or findings and manages personal
not intended for use as an and team, reflecting on discuss outcomes Shows limited ability to connect bias Reflects on ambiguity, outcomes,
assessment instrument. Entrustment
decisions should be made after EPAs
process and outcomes and/or process, outcomes to the process by and the process by which
have been observed in multiple (ADVISE) even with which questions were identified Connects outcomes to process questions were identified and
settings with varying context, acuity, prompting and answered and findings were by which questions were answered and findings were
and complexity and with varying ICS1 ICS2 PBLI1 PBLI8 applied identified and answered applied
patient characteristics.
PBLI9 PC7
7
Cocks P, Cutrer WB, Esposito K, Lupi C, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted
from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 8: Give or Receive a Patient Handover to Transition Care Responsibility
Key Functions with
An EPA: A unit of Related Competencies
observable, measurable Behaviors Requiring  Developing Behaviors  Expected Behaviors for
professional practice Document and update an
Corrective Response (Learner may be at different levels within a row.) an Entrustable Learner
requiring integration of electronic handover tool and
competencies apply this to deliver a structured Inconsistently uses Uses electronic handover tool Consistently updates electronic Consistently updates electronic
standardized format or uses handover tool with mostly handover tool with clear, relevant,
verbal handover Inconsistently updates tool
alternative tool relevant information, applying a and succinct documentation
PBLI7 ICS2 ICS3 P3 standardized template
Requires clarification and Adapts and applies all elements
Provides information that is additional relevant information
EPA 8 *Transmitter incomplete and/or includes from others to prioritize information
Adjusts patient information for
context and audience
of a standardized template

multiple errors in patient Presents a verbal handover that

Give or
receive a
patient
handover
Underlying
entrustability for all
EPAs are
trustworthy habits,
including
truthfulness,
conscientiousness,
and discernment.
This schematic depicts
development of proficiency in the
Core EPAs. It is not intended for
use as an assessment instrument.
Entrustment decisions should be
made after EPAs have been
observed in multiple settings with
varying context, acuity, and
complexity and with varying
patient characteristics.
* Functions are designated as
“transmitter” or “transmitter and
receiver.”
Conduct handover using
communication strategies known
to minimize threats to transition
of care
ICS2 ICS3
*Transmitter
Provide succinct verbal
communication conveying illness
severity, situational awareness,
action planning, and contingency
planning
ICS2 PC8
*Transmitter
Give or elicit feedback about
handover communication and
ensure closed-loop
communication
PBLI5 ICS2 ICS3
*Transmitter and Receiver
Demonstrate respect for patient’s
privacy and confidentiality
P3
*Transmitter and Receiver
information
Is frequently distracted
Carries out handover with
inappropriate timing and
context
Communication lacks all key
components of standardized
handover
Withholds or is defensive
with feedback
Displays lack of insight on
the role of feedback
Does not summarize (or
repeat) key points for
effective closed-loop
communication
Is unaware of HIPAA policies
Breaches patient
confidentiality and privacy
Provides patient information that is
disorganized, too detailed, and/or
too brief
Requires assistance to minimize
interruptions and distractions
Demonstrates minimal situational
awareness
Inconsistently communicates key
components of the standardized
tool
Does not provide action plan and
contingency plan
Delivers incomplete feedback;
accepts feedback when given
Does not encourage other team
members to express their ideas or
opinions
Inconsistently uses summary
statements and/or asks clarifying
questions
Is aware of HIPAA policies
May omit relevant information or
present irrelevant information
Requires assistance with time
management
Focuses on own handover tasks
with some awareness of other’s
needs
Identifies illness severity
Provides incomplete action list
and contingency planning
Creates a contingency plan that
lacks clarity
Accepts feedback and adjusts
Summary statements are too
elaborate
Inconsistently uses repeat-back
technique
Is cognizant of and attempts to
minimize breaches in privacy and
confidentiality
is prioritized, relevant, and
succinct
Avoids interruptions and
distractions
Manages time effectively
Demonstrates situational
awareness
Highlights illness severity
accurately
Provides complete action plans
and appropriate contingency
plans
Provides and solicits feedback
regularly, listens actively, and
engages in reflection
Identifies areas of improvement
Asks mutually clarifying questions,
provides succinct summaries, and
uses repeat-back techniques
Consistently considers patient
privacy and confidentiality
Highlights and respects patient’s
preferences

Aiyer M, Garber A, Ownby A, Trimble G, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program Adapted
from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 9: Collaborate as a Member of an Interprofessional Team
An EPA: A unit of
observable, measurable
professional practice
requiring integration of
competencies
EPA 9
Collaborate as a
member of an
interprofessional
team
Underlying
entrustability for all
EPAs are trustworthy
habits, including
truthfulness,
conscientiousness,
and discernment.
This schematic depicts
development of proficiency in the
Core EPAs. It is not intended for
use as an assessment instrument.
Entrustment decisions should be
made after EPAs have been
observed in multiple settings with
varying context, acuity, and
complexity and with varying
patient characteristics.
7
Brown D, Gillespie C, Warren J, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
Key Functions with
Related
Competencies
Identify team members’
roles and
responsibilities and
seek help from other
members of the team to
optimize health care
delivery
IPC2 SBP2 ICS3
Include team members,
listen attentively, and
adjust communication
content and style to
align with team-member
needs
ICS2/IPC3 IPC1 ICS7 P1
Establish and maintain
a climate of mutual
respect, dignity,
integrity, and trust
Prioritize team needs
over personal needs to
optimize delivery of
care
Help team members in
need
P1 ICS7 IPC1 SBP2
Behaviors
Requiring
Corrective  Developing Behaviors  Expected Behaviors for an
(Learner may be at different levels within a row.) Entrustable Learner
Response
Does not Identifies roles of other Interacts with other team Effectively partners as an integrated
team members but does members, seeks their member of the team
acknowledge other
members of the not know how or when to counsel, actively listens to
use them their recommendations, Articulates the unique contributions
interdisciplinary team
and incorporates these and roles of other health care
as important
Acts independently of input recommendations into professionals
Displays little initiative from team members, practice
to interact with team patients, and families Actively engages with the patient and
other team members to coordinate
members
care and provide for seamless care
transition
Dismisses input from Communication is largely Listens actively and elicits Communicates bidirectionally; keeps
professionals other unidirectional, in response ideas and opinions from team members informed and up to
than physicians
to prompts, or template other team members date
driven
Tailors communication strategy to the
Has limited participation in situation
team discussion
Has disrespectful Is typically a more passive Integrates into team Supports other team members and
interactions or does member of the team function, prioritizing team communicates their value to the
not tell the truth goals patient and family
Prioritizes own goals over
Is unable to modify those of the team Demonstrates respectful Anticipates, reads, and reacts to
behavior interactions and tells the emotions to gain and maintain
truth therapeutic alliances with others
Puts others in position
of reminding, Remains professional and Prioritizes team’s needs over personal
enforcing, and anticipates and manages needs
resolving
emotional triggers
interprofessional
conflicts
EPA 10: Recognize a Patient Requiring Urgent or Emergent Care and Initiate Evaluation and
 Developing Behaviors 
Management Key Functions with Behaviors
(Learner may be at different levels within a row.)
Expected Behaviors for an
Entrustable Learner
Related Requiring
Competencies Corrective Demonstrates limited ability to Recognizes outliers or Recognizes variations of patient’s vital
Response gather, filter, prioritize, and unexpected results or data signs based on patient- and disease-
An EPA: A unit of Recognize normal and
observable, measurable connect pieces of information to and seeks out an explanation specific factors
abnormal vital signs as Fails to recognize
professional practice form a patient-specific
they relate to patient- and trends or variations of
requiring integration of differential diagnosis in an Gathers, filters, and prioritizes
• Chest pain competencies disease-specific factors vital signs in a
urgent or emergent setting information related to a patient’s
• Mental status as potential etiologies of decompensating patient
decompensation in an urgent or
change a patient’s
emergent setting
• Shortness of decompensation
Does not recognize Misses abnormalities in Recognizes concerning Responds to early clinical
breath and change in patient’s patient’s clinical status or does clinical symptoms or deterioration and seeks timely help
PC2 PC4 PC5
hypoxemia not anticipate next steps
• Fever EPA 10 Recognize severity of a
patient’s illness and
clinical status or seek
help when a patient May be distracted by multiple
unexpected results or data
Prioritizes patients who need
• Hypotension or requires urgent or Asks for help immediate care and initiates critical
indications for escalating problems or have difficulty
hypertension Recognize emergent care prioritizing interventions
care and initiate
• Tachycardia or
urgent or interventions and
Accepts help
arrhythmia
emergent management Responds to a Requires prompting to perform Demonstrates appropriate Initiates and applies effective airway
• Oliguria,
situation decompensated patient basic procedural or life support airway and basic life support management, BLS, and advanced
anuria, or cardiovascular life support (ACLS) skills
PC4 PC3 PC2 PC5 PC6 in a manner that skills correctly (BLS) skills
urinary
retention PPD1 detracts from or harms Monitors response to initial interventions
• Electrolyte team’s ability to Does not engage with other Initiates basic management and adjusts plan accordingly

abnormalities Initiate and participate in intervene team members plans Adheres to institutional procedures and
• Hypoglycemia a code response and protocols for escalation of patient care
or apply basic and Seeks input or guidance from
Uses the health care team members
hyperglycemia advanced life support other members of the health according to their roles and
Underlying care team responsibilities to increase task efficiency
entrustability for all PC1 PPD1 SBP2 IPC4 in an emergent patient condition
EPAs are trustworthy
habits, including
truthfulness,
Dismisses concerns of Communicates in a unidirectional Tailors communication and Communicates bidirectionally with the
conscientiousness, Upon recognition of a
team members (nurses, manner with family and health message to the audience, health care team and family about goals
and discernment. patient’s deterioration, care team
family members, etc.) purpose, and context in most of care and treatment plan while keeping
This schematic depicts development of
communicate situation,
about patient deterioration Provides superfluous or situations them up to date
proficiency in the Core EPAs. It is not clarify patient’s goals of
incomplete information to health
intended for use as an assessment care, and update family Actively listens and encourages Actively listens to and elicits feedback
Disregards patient’s goals care team members
instrument. Entrustment decisions members idea sharing from the team from team members (e.g., patient,
should be made after EPAs have been of care or code status
Does not consider patient’s (including patient and family) nurses, family members) regarding
observed in multiple settings with wishes if they differ from those of
varying context, acuity, and complexity ICS2 ICS6 PPD1 concerns about patient deterioration to
the provider Confirms goals of care
and with varying patient determine next steps
characteristics.

Laird-Fick H, Lomis K, Nelson A, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 11: Obtain Informed Consent for Tests and/or Procedures
Behaviors
Key Functions with Requiring Expected Behaviors
Related Corrective  Developing Behaviors  for an Entrustable
An EPA: A unit of
observable, measurable
Competencies Response (Learner may be at different levels within a row.) Learner
professional practice Describe the key Lacks basic Is complacent with informed Lacks specifics when providing Understands and explains
From day 1, requiring integration of the key elements of informed
elements of informed knowledge of the consent due to limited key elements of informed
residents may be in competencies consent
consent: indications, intervention understanding of importance consent
a position to obtain
contraindications, of informed consent Provides complete and
informed consent
Provides inaccurate Lacks specifics or requires accurate information
for interactions, risks, benefits,
or misleading Allows personal biases with prompting
tests, or alternatives, and Recognizes when informed
information intervention to influence
procedures they consent is needed and
order and perform, EPA 11 potential complications
of the intervention
consent process describes it as a matter of
Hands the patient a good practice rather than as
including
form and requests a Obtains informed consent an externally imposed
immunizations,
PC6 KP3 KP4 KP5 P6 signature only on the directive of sanction
medications, Obtain others
central lines,
informed
contrast and Communicate with the
radiation consent Uses language that Uses medical jargon Notices use of jargon and self- Avoids medical jargon
patient and family to frightens patient and corrects Uses bidirectional communication
exposures, and Uses unidirectional
blood transfusions. ensure that they family communication; does not elicit
to build rapport
understand the patient’s preferences
Elicits patient’s preferences by Practices shared decision making,
intervention Disregards emotional asking questions eliciting patient and family
Has difficulty in attending to preferences
cues
Underlying emotional cues Recognizes emotional cues Responds to emotional cues in
entrustability for all PC7 ICS1 ICS7 PC5 real time
EPAs are trustworthy Regards interpreters
Does not consider the use of an
habits, including as unhelpful or Enlists interpreters Enlists interpreters collaboratively
interpreter when needed
truthfulness, inefficient
conscientiousness,
and discernment. Display an appropriate Displays a lack of confidence Has difficulty articulating Demonstrates confidence
Displays
balance of confidence overconfidence and that increases patient stress personal limitations such that commensurate with
This schematic depicts and skill to put the or discomfort, or patient and family will need knowledge and skill so that
development of proficiency in the
takes actions that
patient and family at can have a negative overconfidence that erodes reassurance from a senior patient and family are at
Core EPAs. It is not intended for
use as an assessment instrument. trust colleague ease
ease, seeking help effect on outcomes
Entrustment decisions should be
made after EPAs have been when needed
Asks questions Asks for help Seeks timely help
observed in multiple settings with
varying context, acuity, and
complexity and with varying patient
PPD1 PPD7 PPD8 Accepts help
characteristics.

Obeso V, Biehler JL, Jokela JA, Terhune K, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 12: Perform General Procedures of a Physician
Behaviors
Key Functions with Requiring  Developing Behaviors  Expected Behaviors
Related Corrective (Learner may be at different levels within a for an Entrustable
Competencies Response row.) Learner
An EPA: A unit of
observable, measurable Demonstrate technical Lacks required Technical skills are variably Approaches procedures as Demonstrates necessary
professional practice skills required for the applied mechanical tasks to be preparation for performance of
technical skills
requiring integration of performed and often initiated procedures
procedure Completes the procedure
competencies at the request of others
Fails to follow sterile
• Basic unreliably Correctly performs procedure on
PC1 technique when Struggles to adapt approach multiple occasions over time
cardiopulmonary indicated Uses universal precautions when indicated
resuscitation and aseptic technique Uses universal precautions and
(CPR) inconsistently aseptic technique consistently
• Bag-mask
ventilation (BMC) Understand and explain Does not understand key Describes most of these key Demonstrates and applies

• Sterile technique
EPA 12 the anatomy,
Displays lack of
awareness of
issues in performing
procedures, such as
issues in performing
procedures: indications,
working knowledge of essential
anatomy, physiology, indications,
• Venipuncture physiology, indications, knowledge gaps indications, contraindications, contraindications, risks, contraindications, risks, benefits,
• Insertion of an Perform contraindications, risks, risks, benefits, and benefits, and alternatives and alternatives for each
intravenous line benefits, alternatives, alternatives procedure
general Demonstrates knowledge of
• Placement of a and potential
procedures complications of the Demonstrates limited common procedural Knows and takes steps to
Foley catheter of a knowledge of procedural complications but struggles mitigate complications of
procedure complications or how to to mitigate them procedures
physician minimize them
PC1
Uses jargon or other Conversations are respectful Demonstrates patient-centered
Uses inaccurate
Communicate with the ineffective communication and generally free of jargon skills while performing
language or presents
techniques and elicit patient’s and procedures (avoids jargon,
patient and family to information distorted
family’s wishes participates in shared decision
ensure they understand by personal biases
Underlying Does not read emotional making, considers patient’s
entrustability for all pre- and post- Disregards patient’s response from the patient When focused on the task emotional response)
EPAs are trustworthy procedural activities and family’s wishes during the procedure, may
habits, including Does not engage patient in struggle to read emotional Having accounted for the
truthfulness, Fails to obtain shared decision making response from the patient patient’s and family’s wishes,
conscientiousness, and
PC7 ICS6 P6 appropriate consent obtains appropriate informed
discernment. before performing a consent
procedure
This schematic depicts Displays a lack of confidence Asks for help with Seeks timely help
development of proficiency in the Demonstrate Displays that increases patient’s complications
Core EPAs. It is not intended for overconfidence and stress or discomfort, or Has confidence commensurate
confidence that puts overconfidence that erodes with level of knowledge and skill
use as an assessment instrument. takes actions that
Entrustment decisions should be patients and families at patient’s trust if the learner that puts patients and families at
could endanger
made after EPAs have been ease patients or providers
struggles to perform the ease
observed in multiple settings with procedure
varying context, acuity, and
PPD7 PPD1 Accepts help when offered
complexity and with varying
patient characteristics.

Amiel J, Emery M, Hormann M, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
EPA 13: Identify System Failures and Contribute to a Culture of Safety and Improvement
An EPA: A unit of Behaviors
observable, measurable
Requiring  Developing Behaviors 
professional practice
Key Functions with Related Corrective (Learner may be at different levels within Expected Behaviors for an
requiring integration of
competencies Competencies Response a row.) Entrustable Learner
Identify and report actual and Reports errors in a Superficial understanding Identifies and reports Identifies and reports patient safety
potential ("near miss") errors in disrespectful or prevents recognition of real actual and potential concerns in a timely manner using
care using system reporting misleading manner or potential errors errors existing system reporting structures
structure (e.g., event reporting (e.g., event reporting systems, chain
systems, chain of command
EPA 13 policies)
Demonstrates
structured approach to
of command policies)

describing key elements Speaks up to identify actual and

System of patient safety potential errors, even against
KP1 ICS2 P4 PPD5
concerns hierarchy
failures Participate in system improvement Displays frustration at
Passively observes system Participates in system Actively engages in efforts to identify
and activities in the context of rotations system improvement
improvement activities in the improvement activities systems issues and their solutions
or learning experiences (e.g., rapid- efforts
culture of cycle change using plan–do–study–
context of rotations or when prompted but may
safety act cycles, root cause analyses, learning experiences require others to point
morbidity and mortality conference, out system failures
failure modes and effects analyses,
improvement projects)
PBLI4 PBLI10
Places self or others at Requires prompts for Demonstrates common Engages in daily safety habits with
Engage in daily safety habits (e.g.,
accurate and complete risk of injury or adverse common safety behaviors safety behaviors only rare lapses
Underlying entrustability documentation, including allergies event
for all EPAs are and adverse reactions, medicine
trustworthy habits, reconciliation, patient education,
including truthfulness, universal precautions, hand
conscientiousness, and washing, isolation protocols, falls
discernment. and other risk assessments,
standard prophylaxis, time-outs)
This schematic depicts
development of proficiency in SBP4
Avoids discussing or Requires prompts to reflect Identifies and reflects Identifies and reflects on the
the Core EPAs. It is not Admit one's own errors, reflect on reporting errors; attempts on own errors and their on own contribution to element of personal responsibility for
intended for use as an one's contribution, and develop an to cover up errors underlying factors errors but needs help errors
assessment instrument. individual improvement plan
Entrustment decisions should developing an
be made after EPAs have been Demonstrates May not recognize own improvement plan Recognizes causes of lapses, such
observed in multiple settings defensiveness or places fatigue or may be afraid to as fatigue, and modifies behavior or
P4 SBP5
with varying context, acuity, blame tell supervisor when fatigued seeks help
and complexity and with
varying patient characteristics.

Crowe R, Hyderi A, Rosenfeld M, Uthman M, Yingling S, Obeso V, Brown D, Phillipi C, eds.; for Core EPAs for Entering Residency Pilot Program
Adapted from the Association of American Medical Colleges (AAMC). Core entrustable professional activities for entering residency. 2014.
Appendix 1: Core EPA Pilot Supervision and Coactivity Scales
Scales for clinical supervisors to determine how much help (coactivity) or supervision they judge a student needs for a
specific activity have been proposed—the Chen entrustment scale and the Ottawa scale (Chen et al 2015; Rekman et al
2016). There is limited validity evidence for these scales and no published data comparing them. We include these published
tools here for your reference. The Core EPA Pilot Group has agreed on a trial using modified versions of these scales
(described below). A description of how the pilot is working with these scales is available on the Core EPA website.

Modified Chen entrustment scale: If you were to Corresponding excerpt from original Chen entrustment scale (Chen et al
supervise this student again in a similar situation, which of 2015)
the following statements aligns with how you would assign
the task?

1b. “Watch me do this.” 1b. Not allowed to practice EPA; allowed to observe

2a. “Let's do this together.” 2a. Allowed to practice EPA only under proactive, full supervision as
coactivity with supervisor

2b. “I'll watch you.” 2b. Allowed to practice EPA only under proactive, full supervision
with supervisor in room ready to step in as needed
3a. “You go ahead, and I'll double-check all of your 3a. Allowed to practice EPA only under reactive/on-demand
findings.” supervision with supervisor immediately available, all findings
double-checked
3b. “You go ahead, and I'll double-check key 3b. Allowed to practice EPA only under reactive/on demand
findings.” supervision with supervisor immediately available, key findings
double-checked
Modified Ottawa scale: In supervising this student, how Original Ottawa scale (Rekman et al 2016)
much did you participate in the task?

1. “I did it.” Student required complete guidance or was 1. “I had to do.” (i.e., requires complete hands-on guidance, did not do,
unprepared; I had to do most of the work myself. or was not given the opportunity to do)

2. “I talked them through it.” Student was able to 2. “I had to talk them through.” (i.e., able to perform tasks but requires
perform some tasks but required repeated directions. constant direction)

3. “I directed them from time to time.” Student 3. “I had to prompt them from time to time.” (i.e., demonstrates some
demonstrated some independence and only required independence, but requires intermittent direction)
intermittent prompting.

4. “I was available just in case.” Student functioned 4. “I needed to be there in the room just in case.” (i.e., independence but
fairly independently and only needed assistance with unaware of risks and still requires supervision for safe practice)
nuances or complex situations.

5. (No level 5: Students are ineligible for complete 5. “I did not need to be there.” (i.e., complete independence, understands
independence in our systems.) risks and performs safely, practice ready)
Assoc1at1on of
American Medical Colleges