1.3 Types of training activity
- There are three types of training activity: entrustable training activities, observational training activities and developmental training activities.
- Each training activity’s type will be specified in the specialty curriculum.
- Full details about each type of training activity are outlined below, including:
- The purpose of the activity: why trainees are undertaking the activity.
- The purpose of evidence: what the evidence for the training activity should demonstrate.
- Evidence requirements: the minimum requirements for the appropriate evidence that should be submitted for successful completion of each type of training activity.
- Assessor requirements: who can assess each type of training activity.
1.3.1 Entrustable training activities
- Entrustable professional activities were developed for medical education and are defined as “discrete observable assessable tasks that together attempt to define professional duties”, (…) with learners considered “entrustable” when they are “‘ready to perform’ a given EPA with indirect supervision” [1].
- Entrustable professional activities have been adopted by training programmes for a range of healthcare professionals including programmes delivered by the School. The School has applied this concept as ‘entrustable training activities’.
- Indirect supervision means supervision may not be physically present during the activity but is available to refer to for immediate advice or support as appropriate to the situation; for example, in the next room, over the phone or to provide final approval. In comparison, performing the activity ‘under supervision’ or under ‘direct supervision’ suggests that supervision needs to be physically present during the activity and/or plays an active role in the successful completion of the task.
- The concept of an entrustable training activity does not imply that a trainee must complete the activity in every possible environment, under every possible condition, with all possible patient groups, or a minimum number of times. Each trainee’s learning journey to reach ‘entrustment’ will be different. The concept considers whether the trainee has sufficient skill, experience, and depth of applied knowledge to complete the activity within the remit of their routine ‘professional duties’. In addition, this concept assesses whether the trainee can be trusted to perform the activity safely and effectively in scenarios they have not yet encountered. In such a situation, the trainee would be able to be able to problem-solve, identify non-standard occurrences, recognise their scope of practice and request support and escalate where necessary, to an ensure an appropriate outcome for the situation.
the idea of trust reflects a dimension of competence that reaches further than observed ability. It includes the real outcome of training—that is, the quality of care.
Cate O t. Trust, competence, and the supervisor’s role in postgraduate training, BMJ 2006; 333 :748 doi:10.1136/bmj.38938.407569.94
Entrust: to make somebody responsible for doing something or taking care of somebody.
“entrust.” Oxford Learners Dictionary, https://www.oxfordlearnersdictionaries.com, (18th July 2023)
1.3.2 Training activity types: Purpose and evidence
Non-urgent advice: Entrustable training activities (ETA)
The purpose of the activity
These activities support trainees to develop the skills required for routine post-programme practice in the specialty.
These are activities that are undertaken frequently in the workplace and trainees are expected to be able to perform these activities themselves.
The purpose of the evidence
The evidence submitted should demonstrate that the trainee can be ‘entrusted’ to undertake the task with indirect supervision.
This includes the concept that the trainee can be ‘entrusted’ to know when not to undertake the task themselves either because it is not safe to do so, or because they recognise their own scope of practice with respect to the activity.
Evidence submitted for ETAs must include:
- Evidence that the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, it may not have been appropriate to undertake the task in the circumstances or the trainee recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
- Reflection at multiple points in time on the trainee’s practice of this activity.
Assessor requirements
Assessors should be entrusted to undertake the activity in the workplace themselves, with sufficient experience to be able to critically evaluate the trainee’s performance and evidence.
Non-urgent advice: Observational training activities (OTA)
The purpose of the activity
These activities support trainees to develop an understanding of practice through reflection on observations and experiences.
These activities aim to provide trainees with awareness of the wider context and the impact of their practice.
The purpose of the evidence
The evidence submitted should demonstrate that the observation or experience has contributed to the trainee’s understanding of practice and expanded, challenged, or reaffirmed the trainee’s perspective of practice.
Evidence submitted for OTAs must include:
- Evidence that the observation or experience has been undertaken by the trainee.
- Reflections on the observation or experience including contextualisation to the trainee’s own practice, at two points in time. E.g., a reflection before and after the observation, or reflection one day after an observation and another reflection a week later.
Assessor requirements
Assessors should be familiar with the area of practice and context of the observation or experience undertaken for the training activity.
Non-urgent advice: Developmental training activities (DTA)
The purpose of the activity
These activities support trainees to develop and improve their practice.
These are usually activities which are undertaken less regularly in the workplace and can be used by the trainee to develop insight into their practice.
The purpose of the evidence
The evidence submitted should demonstrate that the activity has contributed to the development of the trainee’s own practice and identified areas of practice for continued development.
Evidence submitted for DTAs must include:
- Evidence that the activity has been undertaken by the trainee
- Reflection on the activity at one or more points in time after the event including reflection on what has been learned from the activity and/or reflection on how it can be used to develop the trainee’s practice.
- An action plan to implement learning and/or to address skills or knowledge gaps identified by the activity.
Assessor requirements
Assessors should be familiar with the requirements for post-programme practice in the specialty area and have sufficient experience of training and development to be able to critically review the trainee’s learning and action plan.
[1] Encandela JA, Shaull L, Jayas A, Amiel JM, Brown DR, Obeso VT, Ryan MS, Andriole DA; Core Entrustable Professional Activities for Entering Residency Pilot. Entrustable professional activities as training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot. Med Educ Online. 2023 Dec;28(1):2175405. doi: 10.1080/10872981.2023.2175405. PMID: 36794397; PMCID: PMC9937016.