Entrustable Professional Activities for Newly Graduated Physician Associates: Validation Through a Modified Delphi Study.

Abstract

Introduction: Entrustable Professional Activities (EPAs) operationalize Competency-Based Medical Education (CBME) by defining observable clinical tasks that learners should be trusted to perform. Although EPA frameworks have been developed for physician training, a validated EPA framework tailored to newly graduated physician associates (PAs) has not been established.

Methods: A modified Delphi study was conducted with 35 experts from PA education and clinical practice. An initial list of 21 EPAs was created through adaptation of existing EPA frameworks and original development aligned with the 2020 PA Competencies. Each EPA was evaluated using the Queen's EPA Quality rubric. Three iterative survey rounds were conducted using Qualtrics. EPAs reaching ≥75% expert consensus were retained. Qualitative feedback was used to refine EPA language between rounds.

Results: Twelve EPAs met the consensus threshold, with all ultimately reaching "Strongly Agree" levels. These were categorized into 5 domains: Establishing Core Clinical Skills, Developing Critical Thinking with Reflective Practice, Developing Interconnected Clinical Skills, Proactive Patient Care Skills, and Enhancing Communication and Cultural Awareness. Participants represented a diverse range of roles, specialties, and geographic regions.

Discussion: This study provides a validated, profession-specific EPA framework for PA graduates. The 12 EPAs align with CBME principles, accreditation standards, and national PA competencies. They offer a structured approach to readiness-to-practice assessment, curriculum development, and faculty training. Future research should evaluate implementation, impact on clinical outcomes, and implications for certification and licensure.