A Systems-Based Approach to Curriculum Development and Assessment of Core Entrustable Professional Activities in Undergraduate Medical Education

Background: In 2014, the AAMC launched a pilot project with 10 institutions to test the feasibility of implementing 13 Core Entrustable Professional Activities (EPAs) for Entering Residency. Methods: The Curriculum and Assessment (C-A) group of the pilot has proposed using a systems-based approach (SBA) as a framework for the development and implementation of EPAs in undergraduate medical education (UME). Based on the seminal concepts of systems thinking, five process-oriented steps define the system, describe a pathway to goal accomplishment, develop connections among people responsible for implementation, prepare for work activities, and plan for continuous quality improvement. Results: The systems-based approach proved to be very well-suited to the specific challenges of implementing EPAs within an existing curriculum. Our results with EPA 11 provided an early indicator of a successful longitudinal and fully integrated approach to educating and assessing students in obtaining informed consent. Conclusions: Pilot project institutions are endorsing the SBA to develop and implement EPAs in UME to encourage scalability, replication, or adaptation, as needed locally and across institutional sites. While the work of the Core EPA pilot project is ongoing, we introduce the SBA to foster early adoption by institutions interested in incorporating EPAs into their current undergraduate medical education programs.