Bridging the gap between dental education and clinical practice: The entrustable professional activities model.

In 2005, the concept of entrustable professional activities (EPAs) was introduced in graduate medical education, including the surgical specialties, to bridge the gap between competency-based education and clinical practice.1ten Cate O. Entrustability of professional activities and competency-based training.Med Educ. 2005; 39: 1176-1177Crossref PubMed Scopus (588) Google Scholar The EPAs model was developed to support decisions about the type of supervision medical residents need when caring for patients in hospital settings. A similar need for progressive entrustment of patient care during the education process has led many health care professions, including pharmacy and veterinary medicine, to embrace EPAs.2ten Cate O. Nuts and bolts of entrustable professional activities.J Grad Med Educ. 2013; 5: 157-158Crossref PubMed Google Scholar This framework has been proposed for dentistry.3Friedrichsen S.W. The ADEA compendium of clinical competency assessments: a potential pathway for licensure.J Calif Dent Assoc. 2020; 48: 321-329Crossref Google Scholar, 4Quinonez R.B. Tittemore A. Mason M. et al.Preparing for implementation of an entrustable professional activity assessment framework.J Dent Educ. 2022; 86: 1529-1534Crossref PubMed Scopus (2) Google Scholar, 5Ehlinger C. Fernandez N. Strub M. Entrustable professional activities in dental education: a scoping review.Br Dent J. 2023; 234: 171-176Crossref PubMed Scopus (2) Google Scholar, 6Ramaswamy V. Fitzgerald M. Danciu T. et al.Entrustable professional activities framework for assessment in predoctoral dental education, developed using a modified Delphi process.J Dent Educ. 2021; 85: 1349-1361Crossref PubMed Scopus (8) Google Scholar, 7Cully J. Schwartz S. Quinonez R.B. Martini A. Klein M. Schumacher D.J. Development of entrustable professional activities for post-doctorate pediatric dentistry education.J Dent Educ. 2022; 87: 6-17Crossref PubMed Scopus (2) Google Scholar EPAs define the tasks or responsibilities of professional practice (the work) that can be entrusted to the trainee without direct supervision once they display competence and trustworthiness.8Shorey S. Lau T.C. Lau S.T. Ang E. Entrustable professional activities in health care education: a scoping review.Med Educ. 2019; 53: 766-777Crossref PubMed Scopus (92) Google Scholar The EPAs model includes longitudinal observations—multiple assessments from multiple assessors in multiple settings—as the learner displays increasing independence over time, with cases of increasing complexity and in authentic clinical settings. The conditions needed for entrustment of the trainee are defined by the following domains of the ARICH framework: Agency (safety, teamwork), Reliability (consistently displaying independence), Integrity (professionalism, benevolence), Capabilities (ability to show the execution of procedures), and Humility (ability to understand one’s limitations and receive feedback).9ten Cate O. Chen H.C. The ingredients of a rich entrustment decision.Med Teach. 2020; 42: 1413-1420Crossref PubMed Scopus (38) Google Scholar In 2018, the American Dental Education Association, American Dental Association, and American Student Dental Association convened the Task Force on Assessment of Readiness for Practice10Report of the Task Force on Assessment of Readiness for Practice: A Joint Task Force of American Dental Association, American Dental Education Association and American Student Dental Association. American Dental Association, 2018https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/licensure/report_taskforce_assessment_of_readiness_for_practice.pdf?rev=c6a406c4d2a54af4a0f3024fed953707&hash=6B9FD550E438F69DEAAADF2F05378E4EDate accessed: May 26, 2023Google Scholar to address license portability and challenges associated with single-encounter, patient-based, clinical examination for dental licensure. The report emphasized an environment of trust necessary for any proposed changes, to be fostered through collaboration and transparency. They defined the need for valid and reliable assessments of psychomotor skills and relevant patient care knowledge, skills, and abilities that include data collected over time, representing graduates’ competence, independence, and readiness for practice. Dental licensing boards, dental schools, and the public must be able to trust these data and subsequent decisions.3Friedrichsen S.W. The ADEA compendium of clinical competency assessments: a potential pathway for licensure.J Calif Dent Assoc. 2020; 48: 321-329Crossref Google Scholar ln response to the Task Force on Assessment of Readiness for Practice Report, the American Dental Education Association Compendium on Clinical Competency Assessment (the Compendium) was established to provide another option or path to clinical licensure that could also support portability. The Compendium is a national platform and archive for selected assessment data collected during the education process, which dental schools can use to benchmark educational outcomes and state dental boards can use to support licensure decisions. It requires standardized assessment data and calibrated faculty evaluators. These assessments must measure the student’s ability to perform the work of a dentist independently and consistently at a level that meets or exceeds the defined criteria on multiple occasions and in a variety of settings. To ensure these data bridge the gap between competency assessment and clinical practice, the Compendium Steering Committee recommended an EPAs framework for assessment and created a work group to develop this framework. Then, in March 2020, as state restrictions for the COVID-19 pandemic disrupted dental education and dental practices, dental schools responded with a temporary suspension of nonessential activities, including didactic classroom, simulation, and nonurgent clinical care. Educators, state boards of dentistry, and dental examiners relied on more flexible ways of knowing and assessing the competence of new dental graduates to fulfill the ethical obligation to ensure the safety of the public they serve, while answering the fundamental question “Can this new dentist be entrusted with independent patient care as a safe beginner?” Amid the pandemic, state dental boards also transitioned temporarily from patient-based clinical licensure examinations to manikin- and computer-based simulation examinations. Dental schools have since returned to prepandemic conditions and have retained some of the positive innovations necessitated by the pandemic. As educators were forced to rethink their assessments, the validity and reliability of predicting future clinical performance after graduation have been questioned. How valid and reliable is a single-encounter, patient-based, procedure-oriented assessment that focused on skills and procedure outcomes for minimally complex and ideal cases when we need to predict future performance of the new graduate in contemporary dental practice with all its complexity? Can we do better? The EPAs framework offers an innovative approach to competency assessment that includes the assessment of trustworthiness as well as a potentially more accurate summative assessment of competency. The EPAs work group of the American Dental Education Association Compendium includes more than 10 dental schools that are creating the national EPA for the new dental graduate. Several schools have already adopted EPAs frameworks in their curricula. The EPAs model uses longitudinal observations that measure different aspects of competency, including trustworthiness, knowledge, skills, and behaviors. It requires the professional judgment of multiple calibrated faculty clinicians with direct knowledge of the learner’s performance in the clinic to make entrustment decisions. Therefore, the EPAs model provides a more robust assessment to more accurately and objectively identify graduates who are not yet ready, customize their educational experience, predict future performance in clinical practice, and ensure the practice readiness of all graduates. This framework and the associated data can further align and inform future employers about the graduates’ capabilities. Using EPAs as the framework allows for a more standardized approach to assessment of practice readiness across schools. As a national resource, by means of transparently sharing our data with licensing boards and one another, we can foster trust between the education and practice communities, as well as the public.11Training and certification: entrustable professional activities. The American Board of Surgery.https://www.absurgery.org/default.jsp?epahomeDate accessed: May 10, 2023Google Scholar Accreditation standards and the accreditation process will need to be modified to explicitly support and complement this holistic approach to assessment of clinical competency and interface with the informatics resources to facilitate the implementation of this new model in dental education programs across the entire spectrum of allied dental, predoctoral, and advanced dental education. Most health care professions with educational programs that prepare graduates for independent practice have adopted national EPAs frameworks for assessment for the reasons identified previously.11Training and certification: entrustable professional activities. The American Board of Surgery.https://www.absurgery.org/default.jsp?epahomeDate accessed: May 10, 2023Google Scholar, 12The core entrustable professional activities for entering residency. Association of American Medical Colleges.https://www.aamc.org/about-us/mission-areas/medical-education/cbme/core-epasDate accessed: May 10, 2023Google Scholar, 13Competency-based veterinary education: entrustable professional activities. Association of American Veterinary Medical Colleges.https://www.aavmc.org/wp-content/uploads/2020/10/CBVE-Publication-2-EPA.pdfDate accessed: May 10, 2023Google Scholar, 14Haines S.T. Pittenger A.L. Stolte S.K. et al.Core entrustable professional activities for new pharmacy graduates.Am J Pharm Educ. 2017; 81: S2Abstract Full Text Full Text PDF PubMed Google Scholar As the importance of oral health in systemic health is elevated, and medical-dental integration becomes more widespread, sharing a common language around our educational outcomes can enhance our collaborations with other health care professions. Furthermore, the EPAs model provides a great opportunity to build on advancements in education, curriculum, and competency assessment; to improve the ability of dental schools, state dental boards, and the profession to ensure the public and each other of the quality of our dental graduates and their readiness for independent, safe, and high-quality clinical practice.The entrustable professional activities model provides an opportunity to build on advancements in education to improve the ability of dental schools, state dental boards, and the profession to ensure practice readiness of our graduates. The entrustable professional activities model provides an opportunity to build on advancements in education to improve the ability of dental schools, state dental boards, and the profession to ensure practice readiness of our graduates. Dr. Quinonez is a professor and associate dean for curriculum, Division of Pediatric Dentistry and Public Health, University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC. Dr. Danciu is a professor, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI. Dr. Ramaswamy is the director of evaluation and promotion of teaching and learning, University of Michigan School of Dentistry, Ann Arbor, MI. Dr. Murdoch-Kinch is a professor, Department of Oral Pathology, Medicine and Radiology, and interim chancellor, Indiana University–Purdue University Indianapolis, Indianapolis, IN.