Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students

Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of ‘Entrustable Professional Activities’ (EPAs) encompasses supervisors’ decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear. Objective: How do FOC perceptions relate to entrustment-decisions? Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs. Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings. Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs. Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.