A MILESTONE IS AN OBSERVABLE MARKER ALONG A DEVELOPMENTAL CONTINUUM

For the purposes of learning and improvement, a resident and supervisor can focus on the EPA as a whole, or examine the milestones linked to that EPA.  Over time, this detail is needed to help guide feedback and coaching for improvement.

Milestones allow you as an observer to pinpoint areas that trainees need to improve in order for them to successfully complete the EPA.

ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAS)  ARE THE KEY TASKS OF A DISCIPLINE THAT A PRACTITIONER NEEDS TO BE ABLE TO PERFORM.

EPAs are authentic tasks of a discipline.  A supervisor can delegate a task to a resident and observe their performance in the workplace.  Over time, frequent observations of a resident’s performance of an EPA will provide a comprehensive image of their competence.

The key difference between EPA’s and milestones is that EPA’s are the tasks or activities that must be accomplished, whereas milestones are the abilities of the individual.  

The Royal College EPAs are related to each stage of training.  EPAs are designed to be developmental – they go from smaller tasks to bigger tasks as residents progress.  EPAs are both procedural as well as clinical.  EPAs can be used for non-clinical tasks as well.  EPA’s however, are likely only one piece of their total programmatic assessment strategy.

BENEFITS OF MILESTONES & EPAS

• Link clinical activities with learning and assessment,
• Clearly defined targets for acquiring competency and meeting standards throughout training.
• Better preparation to serve patients and communities, and
• Strive towards mastery of skills and abilities beyond training and throughout practice.

AS A TEACHER

• Focus on specific clinical activities with residents at different stages,
• Focus on teaching towards specific milestones within a stage, and
• Conduct assessments of specific EPAs.

UNPACK MILESTONES

EPAs and milestones provide meaningful, measurable markers of progression. If a resident is struggling with an EPA, the teacher can break down the EPA into abilities (milestones).