Entrustable professional activities for nutrition and dietetics practice: Theoretical development

Olivia Renee Louise Wright, Sandra Maureen Capra



 Background: Nutrition and dietetics competencies in Australia have recently changed to incorporate greater emphasis on client-centredness, flexibility, marketing skills, advocacy and a systems-based approach to practice. This study examined the translation of the new competency standards into a series of entrustable professional activities (EPAs) to achieve authentic assessment practice. 

Methods: An iterative, multiple-methods approach was used. Two senior academic dietitian-nutritionists conceptualised key tasks for everyday practice and devised a list of 14 EPAs. Face validity of the 14 EPAs, new curriculum and assessment plans was established through expert review and presentation to four dietetics department directors and 10 clinical educators. Dietetics students trialled the new assessment procedure. 

Results: Each domain of competence was included in 9–10 EPAs. Each EPA included the demonstration of 12–21 key tasks/elements. The EPAs were positively received by expert reviewers and were considered a strong framework. Students considered the EPA assessment process easier than previous competency-based methods and reported a higher recognition of learning and skills development. 

Conclusions: EPAs are feasible for translating competency standards into a workplace-driven nutrition and dietetics curriculum and are an effective catalyst for curriculum and assessment modifications to drive the development of client-centred and entrepreneurial dietetics professionals.


Authentic assessment, entrustable professional activities, nutrition and dietetics

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Caverzagie, K. J., Cooney, T. G., Hemmer, P. A., & Berkowitz, L. (2015). The development of entrustable professional activities for internal medicine residency training. Academic Medicine, 90(4), 479–484.

Chang, A., Bowen, J. L., Buranosky, R. A., Frankel, R. M., Ghosh, N., Rosenblum, M. J., . . . Green, M. L. (2013). Transforming primary care training: Patient-centred medical home entrustable professional activities for internal medicine residents. Journal of General Internal Medicine, 28(6), 801–809.

Dietitians Association of Australia (DAA). (2015). National competency standards for dietitians in Australia. Retrieved from http://daa.asn.au/wp-content/uploads/2015/12/NCS-Dietitians-Australia-1.0.pdf

Englander, R., Flynn, T., Call, S., Carraccio, C., Cleary, L., Fulton, T., . . . Lypson, M. L. (2014). Core entrustable professional activities for entering residency: Curriculum developers' guide. Washington, DC: Association of American Medical Colleges.

Englander, R., Flynn, T., Call, S., Carraccio, C., Cleary, L., Fulton, T. B., . . . Aschenbrener, C. A. (2016). Toward defining the foundation of the MD degree: Core entrustable professional activities for entering residency. Academic Medicine. Advance online publication. doi:10.1097/acm.0000000000001204

Fish, D., & De Cossart, L. (2006). Thinking outside the (tick) box: Rescuing professionalism and professional judgement. Medical Education, 40(5), 403–404. doi:10.1111/j.1365-2929.2006.02441.x

Frank, J. R. (2005). The CanMEDS 2005 physician competency framework: Better standards. Better physicians. Better care. Ottawa, Canada: The Royal College of Physicians and Surgeons of Canada.

Frank, J. R., & Danoff, D. (2007). The CanMEDS initiative: Implementing an outcomes-based framework of physician competencies. Medical Teacher, 29(7), 642–647. doi:10.1080/01421590701746983

Frank, J. R., Snell, L. S., ten Cate, O., Holmboe, E., Carraccio, C., Swing, S.,

. . . Dath, D. (2010). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638–645.

Hauer, K. E., ten Cate, O., Boscardin, C., Irby, D. M., Iobst, W., & O’Sullivan, P. S. (2014). Understanding trust as an essential element of trainee supervision and learning in the workplace. Advances in Health Science Education: Theory and Practice, 19(3), 435–456.

Hauer, K. E., Kohlwes, J., Cornett, P., Hollander, H., ten Cate, O., Ranji, S. R., . . . O’Sullivan, P. S. (2013). Identifying entrustable professional activities in internal medicine training. Journal of Graduate Medical Education, 5(4), 54–59.

Hodges, B., & Lingard, L. (2012). The questions of competence: Reconsidering medical education in the twenty-first century. New York, NY: Cornell University Press.

Mulder, H., ten Cate, O., Daalder, R., & Berkvens, J. (2010). Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training. Medical Teacher, 32(10), e453–e459. doi:10.3109/0142159X.2010.513719

Palermo, C., Conway, J., Beck, E. J., Dart, J., Capra, S., & Ash, S. (2016). Methodology for developing competency standards for dietitians in Australia. Nursing & Health Sciences, 18(1), 130–137. doi:10.1111/nhs.12247

Shaughnessy, A. F., Sparks, J., Cohen-Osher, M., Goodell, K. H., Sawin, G. L., & Gravel, J. (2013). Entrustable professional activities in family medicine. Journal of Graduate Medical Education, 5(1), 112–118.

ten Cate, O. (2013). Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education, 5(1), 157–158.

ten Cate, O., Chen, H. C., Hoff, R. G., Peters, H., Bok, H., & van der Schaaf, M. (2015). Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE Guide No. 99. Medical Teacher, 37(11), 983–1002. doi:10.3109/0142159X.2015.1060308

ten Cate, O., Hart, D., Ankel, F., Busari, J., Englander, R., Glasgow, N.,

. . . Wycliffe-Jones, K. (for the International Competency-Based Medical Education Collaborators). (2016). Entrustment decision making in clinical training. Academic Medicine, 91(2), 191–198. doi:10.1097/acm.0000000000001044

ten Cate, O., & Scheele, F. (2007). Viewpoint: Competency-based postgraduate training. Can we bridge the gap between theory and clinical practice? Academic Medicine, 82(6), 542–547. doi:10.1097/ACM.0b013e31805559c7

Touchie, C., & ten Cate, O. (2016). The promise, perils, problems and progress of competency-based medical education. Medical Education, 50(1), 93–100. doi:10.1111/medu.12839

Weidman, J., & Baker, K. (2015). The cognitive science of learning: Concepts and strategies for the educator and learner. Anesthesia & Analgesia, 121(6), 1586–1599. doi:10.1213/ane.0000000000000890

DOI: https://doi.org/10.11157/fohpe.v18i3.143


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