Using Backward Design to Align the Core Clerkships with the EPAs

Since the publication of the Entrustable Professional Activities (EPAs) project by the Association of American Medical Colleges (AAMC), institutions have been exploring how to integrate and assess EPAs into a pre-existing medical education curricular structure. Here, we describe a systematic approach for achieving this task using the third year Core Clerkships as a model. We utilized the process of Backward Design to integrate the EPAs into our existing third year Core Clerkship Curriculum by creating common student learning outcomes and implementing a standardized assessment strategy. Specifically, our manuscript shares the process we used, barriers we faced, methods to evaluate the changes, our ideas to continue to improve this process in the future, and how other institutions can generalize this process. Our redesign efforts revealed that many perceptors were unable to evaluate student performance on key EPA-based outcomes we identified as appropriate to the third year. This finding has implications for how to begin making Entrustment decisions by helping to better establish where key entrustable performances are best observed and assessed.