ORIGINAL ARTICLE Implementing entrustable professional activities: the yellow brick road towards competency-based training? David Moore, Christopher J. Young and Jonathan Hong Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Key words competency, curriculum, entrustable, surgery, work place assessment. Correspondence Associate Professor Christopher J. Young, Department of Colorectal Surgery, Royal Prince Alfred Hospital Medical Centre, Suite 415, 100 Carillon Avenue, Newtown, NSW 2042, Australia. Email: cyoungnsw@aol.com D. Moore MBBCh, BAO (Hons); C. J. Young MS, FRACS, FACS; J. Hong MBBS, MS, FRACS. Accepted for publication 30 May 2017. doi: 10.1111/ans.14120 Abstract Background: We describe implementation of competency-based postgraduate surgical training, using an entrustable professional activities (EPAs) programme. The programme aims to improve patient outcomes by optimizing supervision of surgical trainees, creating opportunities for additional teaching and feedback. The curriculum was designed to maxi- mize feasibility for implementation within a colorectal surgical department. Methods: The curriculum was developed using previously described methods by consen- sus between two consultants within the department. Seven EPAs were identified and described for each grade of trainee. A consultant within the teaching faculty or a delegate is required to assess each EPA and provide formal feedback until the trainee is given permis- sion to act autonomously. Results: It is hoped the programme can progress with minimal disruption to key stake- holders. We will record trainee assessment data anticipating that performance of trainees on other tasks in the future may provide some evidence of validity for the EPA assessments. Conclusions: There are perceived benefits and problems evident in the EPA model at this early stage of implementation. The programme should result in an increase in the number of formative assessments and feedback opportunities for trainees. The assessment process is famil- iar to supervisors, which should facilitate implementation of the curriculum. There is concern that supervisors may require further training to ensure the assessment process is objective and reproducible. The EPA programme could make the process of delegating patient care to trainees more transparent, but we have not identified a method of widely disseminating trainee assess- ment data without the potential to prejudice trainees unfairly. Introduction We describe our approach to implementing competency-based post- graduate surgical training using an entrustable professional activ- ities (EPAs) programme. The programme is an attempt to meet the requirements of patient care, trainees, supervisors, hospital adminis- tration and postgraduate surgical training organizations in Australia. It aims to improve patient outcomes by formalizing the delegation of workplace tasks, and also creating opportunities for additional teaching and feedback. The programme is designed to ensure feasibility and to limit demand on hospital resources. We discuss the benefits and potential areas for further development and programme assessment, during implementation in out-hospital unit. Background Supervisors balance the competing interests of training and safety when deciding the tasks they allow trainees to perform and how closely they are supervised. In the traditional model of surgical training, these ‘entrustment’ decisions are made by informal observation, often with an assumption that the amount of time spent in postgraduate training confers a level of competence. 1,2 There is little record kept of these important decisions, and the means by which they are reached. This process of delegating clinical work can seem opaque to patients, families and other health professionals. The curriculum was developed partly in response to a request by our hospital administration to demon- strate how surgical supervisors arrive at a decision to allow a trainee to operate independently, also described as entrustment. 2 The requirement by postgraduate training organizations to incor- porate competency frameworks into surgical education was another motivation behind the new programme. 3 Medical educators in Australia, and internationally, have embraced competency frame- works as the standard of training. 3–5 The Royal Australasian Col- lege of Surgeons (RACS) in Australia and General Surgeons Australia promote nine competencies to guide training and © 2017 Royal Australasian College of Surgeons ANZ J Surg (2017) ANZJSurg.com