Entrustable Professional Activities (EPAs)

EPA 101 Psychiatry

In CBD, Entrustable Professional Activities (EPAs) are defined by the Royal College as “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 trainee’s performance of an EPA, will provide a comprehensive image of their competence and inform promotion decisions.” EPA example: Develop and implement a management plan in a patient with a common mental health concern.

EPAs are related to each stage of training (see competency stage graphic here). EPAs are designed to be developmental — they go from smaller tasks to bigger tasks as trainees progress through stages of training. Each EPA integrates a number of milestones from different CanMEDS roles; a bigger task may include more milestones and/or more complex milestones.

The Department of Psychiatry adopted the Royal College's EPAs in July 2020.

  • Transition to Discipline (first 1-3 months) has 2 EPAs.
  • Foundations of Discipline (end of the Transition to Discipline through to the end of PGY2) has 5 EPAs.
  • Core of Discipline (essentially PGY3 and PGY4) has 13 EPAs. Both COD6 and COD7 have two parts. 
  • Transition to Practice (PGY5) has 6 EPAs. TTP1 has two parts (A, and B) and TTP3 has three parts (A, B, and C).

An overview of the existing EPAs is available here:  EPAs Overview. Detailed information regarding specific EPAs can be below in the Royal College EPAs section.

How are EPAs Assessed?

EPAs are completed using the University of Toronto's Elentra system. Faculty and Residents can login using their UTORid and password.  If you are experiencing issues logging on, or require help resetting an EPA please contact Tammy Mok (tammy.mok@utoronto.ca).

EPA General Guidelines

  1. Residents and faculty can initiate EPAs. In most cases, residents have been initiating EPAs but faculty are permitted to do so as well. EPAs can be completed by psychiatry faculty/staff, residents, and allied health. At least 51% of each EPA must be completed by staff and up to 49% of each EPA can be completed by residents or allied health professionals.
  2. EPAs are to be initiated within a week of an encounter as they are meant to be brief, low stakes, “in the moment” assessments. Retroactive submission of EPAs beyond 7 days of the encounter will not be counted. Assessors should be completing these assessments within the week of initiation. Faculty EPA completion rates will be monitored by the program. Residents are discouraged from sending multiple EPAs to a single supervisor (i.e. an EPA “bolus”) for completion.
  3. As per UofT PGME guidelines, EPAs expire 7 days after the date of initiation. The program will allow for one additional extension of another 7 days. The duration of completion should be no more than 2 weeks from the date of initiation. Residents/faculty can reach out to Tammy Mok (tammy.mok@utoronto.ca) for an extension.
  4. Residents are encouraged to concentrate on EPAs corresponding to their current stage of training. Residents are permitted to reach forward to EPAs in the next stage of training. i.e. a resident in FOD can reach forward and attempt EPAs in COD but should not be attempting TTP EPAs.

Please see our user guide for supervisors below:

What does Entrustment mean?

Tips on assessing EPAs and entrustment levels

 

EPA Observations

Generally, residents should aim to complete at least 1 EPA a week during their core rotation. During the LAE, residents should attempt to complete at least 1 EPA every other week. 

The numbers listed below are estimates based on the above guideline. These targets may be adjusted accordingly for each resident due to leaves, redeployment, or other events. We have not adjusted for vacation time. 

The below information is also available for download: EPA Attempt Targets

PGY1 (Transition to Discipline - TTD and Foundations of Discipline - FOD)

ROtation Recommended EPA attempts  
CAMH-ER  4  
Consultation-Liaison Psychiatry 4  
Psychiatry ER (home site) 4  
PLEX (Clinical/Research) 4  
Underserved Marginalized Selective 4  
Behavioural Neurology 1  
Emergency Medicine 1  
Family Medicine or Pediatrics 1  
General Internal Medicine 2 (1 per 1-month block)  
General Neurology 1  
Palliative Care 1  
Longitudinal Ambulatory Experience 1  (LAE1) 24  
TOTAL 51  

PGY2 (Foundations of Discipline - FOD)

ROtation Recommended EPA attempts  
Chid & Adolescent Psychiatry (4 months) 17  
Inpatient Psychiatry (4 months) 17  
Addictions Psychiatry (2 months) 8  
PLEX (Clinical/Research) (2months) 8  
Longitudinal Ambulatory Experience 2 (LAE2) 26  
TOTAL 76

PGY3 (Core of Discipline - COD)

ROtation Recommended EPA attempts  
Geriatric Psychiatry (3 months) 17  
Severe & Persistent Mental Illness (3 months) 17  
PLEX (Clinical/Research) (1 month) 4  
Psychiatry ER (2 months) 8  
Underserved Marginalized Selective (2 months) 8  
Longitudinal Ambulatory Experience 3 (LAE3) 26  
TOTAL 76

PGY4 (Core of Discipline - COD)

ROtation Recommended EPA attempts  
Consultation-Liaison Psychiatry (3 months) 13  
Inpatient Psychiatry (3 months) 13  
PLEX (Clinical/Research) (4 months) 17  
Addictions Psychiatry  (2 months) 8  
TOTAL 51

PGY5 (Transition to Practice - TTP)

ROtation Recommended EPA attempts  
Senior PLEX (12 months) 52  
Integrated Mental Health Care (IMHC) (12 months) 26  
TOTAL 78

EPA Entrustment

EPA Entrustment requirements will differ depending on when a resident began residency.

Residents who began residency prior to the official RCPSC launch of CBD for psychiatry on July 1, 2020 (2017, 2018, 2019 - current PGY3s, PGY4, and pilot PGY5s) need to have 3 entrustments for each EPA, unless the RC requirement is less than 3. An overview is available for download.

Residents who began residency from 2020 onwards (current PGY1s and 2s) require entrustments per RC requirements. A summary table is available for download

Royal College EPAs

As of July 2020, all Psychiatry training programs adopted the Royal College of Physicians and Surgeon's Entrustable Professional Activities.  The EPAs are available for download and viewing below. 

Transition to Discipline

TTD1 OBTAINING A PSYCHIATRIC HISTORY to inform the preliminary diagnostic impression

TTD2 COMMUNICATING CLINICAL ENCOUNTERS in oral and written/electronic form

Foundations of Discipline

FOD1 Assessing, diagnosing and participating in the management of patients with MEDICAL PRESENTATIONS relevant to psychiatry

FOD2 PERFORMING PSYCHIATRIC ASSESSMENTS referencing a biopsychosocial approach, and developing basic differential diagnoses for patients with mental disorders

FOD3 Developing and implementing MANAGEMENT PLANS for patients with presentations of low to medium complexity

FOD4 Performing RISK ASSESSMENTS that inform the development of an acute safety plan for patients posing risk for harm to self or others

FOD5 Performing CRITICAL APPRAISAL and presenting psychiatric literature

Core of Discipline

COD1 Developing COMPREHENSIVE treatment/management PLANS for adult patients

COD2 Performing psychiatric assessments and providing differential diagnoses and management plans for CHILDREN AND YOUTH

COD3 Performing psychiatric assessments, and providing differential diagnoses and management plans for OLDER ADULTS

COD4 Developing comprehensive biopsychosocial FORMULATIONS for patients across the lifespan

COD5 Identifying, assessing, and managing emergent situations in psychiatric care across the lifespan (EMERGENCIES)

COD6-A Integrating the principles and skills of psychotherapy into patient care (PSYCHOTHERAPY MODALITY)

COD6-C Applying and integrating psychosocial skills and principles in general psychiatric care (INTEGRATING PSYCHOTHERAPY SKILLS)

COD7A-B Integrating the principles and skills of NEUROSTIMULATION into patient care

COD8 Integrating the principles and skills of PSYCHOPHARMACOLOGY into patient care

COD9 Applying relevant legislation and LEGAL principles to patient care and clinical practice

COD10 Providing TEACHING to students, residents, public and other health care professionals

Transition to Practice

TTP1-A Managing the clinical and administrative aspects of a psychiatric practice: patient care (PRACTICE MANAGEMENT - PATIENT)

TTP1-B Managing the clinical and administrative aspects of a psychiatric practice: working with the team (PRACTICE MANAGEMENT - TEAM)

TTP2 SUPERVISING junior TRAINEES

TTP3-A Developing and implementing personalized learning experiences geared to career plans or future practice: DEVELOPING A LEARNING PLAN

TTP3-B Developing and implementing personalized learning experiences geared to career plans or future practice: IMPLEMENTING A TRAINING EXPERIENCE

TTP3-C Developing and implementing personalized learning experiences geared to career plans or future practice: REFLECTING ON LEARNING PLAN EFFICACY

EPA Maps and Rotation Cards

OverviewPsychiatry EPAs by Stage

PGY1 (applicable to learners who began residency in July 2020 and after)

PGY1 Rotation Cards TTD FOD

EPA Map for PGY1 TTD FOD

PGY2 (applicable to learners who began residency in July 2020 and after)

PGY2 Rotation Cards FOD 

EPA Map for PGY2 FOD 

PGY3 (applicable to learners who began residency in July 2018, 2019)

PGY3 Rotation Cards COD

EPA Map for PGY3 COD 

PGY4 (applicable to learners who began residency in July 2017, 2018, 2019)

PGY4 Rotations Cards COD 

EPA Map for PGY4 COD