http://www.cswe.org/Accreditation/EPASImplementation.aspx

The entrustable professional activity (EPA) concept emerges in medical teaching. The EPAs were designed to link competencies to clinical practice and make them feasible. The EPAs—tasks or responsibilities that can be entrusted to a trainee once sufficient, specific competence is reached to allow for unsupervised execution—are now being defined in various health care domains. Because EPAs represent what physicians do in daily practice, the new language can be briefer and less complicated.

The word competency has caught on quickly and is now being used ubiquitously.  The competencies are different from knowledge-skills-attitudes (KSA), many consider the competencies to be ‘‘more integrated’’ than the KSAs.

By "EPAs" I believe you mean "entrustable professional activities".  A concise description of these and their relation to competencies is given by Olle ten Cate, who I believe originally used the term EPAs.  I have attached it, and it can be found easily on the internet.  The core of the notion is that as one develops competence in various areas, there are different levels of competence ranging from novice to expert.  Along the way, there is a point where a learner can be trusted to have the knowledge and skill to carry out a particular activity.  So, EPAs are compatible with, grow out of, the notion of competence.

There is a very nice taxonomy of competencies in medical education that has been put together by some people at the Association of American Medical Colleges (AAMC).  I'm attaching their paper (Englander et al, Academic Medicine, August 2013), and one can see from it that there are many different areas in which it is desirable and usually essential for medical students to develop competence.

It is great to know from the first answer to your question that there are multiple uses of EPA and that EPAS is different from EPAs.  That isn't surprising.  Often an acronym has multiple meanings, even in the same general field such as health professions education.

The EPAs, as mentioned in a previous answer, appear to be well received. They have the potential to bridge the gap between the school or national knowledge objectives; for example, in psychiatry, Association of Directors of Medical Student Education in Psychiatry (ADMSEP) learning objectives and the ACGME milestones for psychiatry (links below). Residency training directors could potentially screen the candidates based on documentation of their ability to perform EPAs, as documented in letters or core course/elective comments. The burden is on medical schools to assess EPAs in year 4 of training (here in US - where med school is a 4 year program).

http://www.admsep.org/

http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf

thanks dr stephen and adriana for your responce to my question.i think that EPAs are user friendly both for students and facilitators but at the same time there is a bit of problem of restricting learners to certain specific EPAs ,competencies and learning outcomes is bit unfair as it will affect their creativity as is thoyght by other medical educationists.

I think you have put your finger on an interesting and complicated point.  Should competencies be thought of rigidly or not?  I think it is legitimate for groups of people to determine that every learner in a particular discipline should be competent at a minimum set of things.  The fact that that minimum is a pretty large number in most professions is why it takes a significant time to develop those competencies to a suitable level.  But, it is critical to remember that it is the minimum considered necessary.  So, if someone wants to develop other areas of competence and bring those into the practice of that discipline, that can be done.  But if someone argues that s/he should master some area of competence not considered necessary for the discipline  by a group of "experts" at the expense of mastering a competence considered "necessary", then the burden of proof should rest with the person who doesn't want to focus on the "necessary".  

I would note that a similar issue comes up with respect to clinical guidelines.  Some consider them to be "cookbooks".  But the fact is that every great restaurant has recipes; and we go back to a restaurant or recommend it to others because we know that whoever is cooking that particular day will have mastered the recipes.  Those same restaurants will usually have "specials" - dishes that are not always on the menu and may have been introduced by an innovative cook for that day.  The specials can be considered analogous to bringing special knowledge into practice; but they do not replace the need for the basic competencies to have been mastered.

Steve

This is an interesting conversation.  In the undergraduate medical program I work in, the EPAs are so far being viewed as pertaining to Graduate Medical Education (i.e., residency), and therefore they are what we are intending our graduates to be ready to pursue when they are matched to their residency.  As an instructional systems designer for an undergraduate medical school curriculum in the U.S., I consider "skills" to be what a learner can demonstrate competency in as they move through educational experiences.  That is, as they are learning, they are fortifying their knowledge, skills, and attitudes to become competent physicians.  "Competence" is regarded more as the attainment of a standard (one is either competent or not, based on meeting clearly defined thresholds), which is distinct from having a competency-based curriculum, which we currently do not have. "Competencies" tends to be used as shorthand for standards-based objectives.  I'm not sure why that is. 

thanks Bonnie for nice comments.I too think that for undergrad learners it would be difficult to define and implement the concept of EPAs.Under grad learners could be entrusted upon for simpler tasks keeping the patients safety in mind.On the other hand competencies tend to be more observable and measurable for assessment purpose as well.i am new to the world of medical education and i think its more like an art rather than a science to work as a medical educationist.

This is an interesting discussion so far. I think that while here in the US, we are extremely sophisticated in measuring knowledge (see NBME, specialty Boards), we are only now starting to standardize ways in which we measure skills and attitudes. Although this is an "art", literature is emerging about tools to deliberately practice and  assess skills, including high-tech simulation in procedure oriented areas, and low tech simulation in communication. A journal like Simulation in Healthcare reflects these trends quite well.

Hi Salma, the idea of scaffolding is really crucial to instructional design and development, as I'm sure you're aware.  I find that in my consultation with Clinician instructors, there is starting to be more awareness that we need to look at the big picture of where we want the MD to be upon graduation, and not remain mired in discrete objectives removed from the context they will be applied to.  My oft-repeated question, is "Yes, I understand what you want them to know, but what do you want them to be able to do in practice, not merely for the quiz?"

Salma, as alluded to in both Adriana and Bonnie's answers, in the U.S. there is work on developing methods for attaining competence in a set of EPAs that apply to the undergraduate years of medical school.

Sorry, I sent my response above before finishing it. The lead role in specifying the EPAs has been the Association of American Medical Colleges (AAMC). I'm attaching a document that gives you an idea of how this is progressing. The idea of having competencies and developing competence in each competency has extended in the U.S. into graduate medical education. Each specialty has come up with a variety of competencies that fit into a framework specified by the ACGME (Accreditation Council for Graduate Medical Education). That, in turn, has led to specification of "milestones" to be reached in the process of attaining the required competency. There is now a lot of work on how best to teach or coach learners and how best to assess their progress in becoming competent.

thank you Mr Schoenbaum.