The Fate of Entrustable Professional Activities After Graduation: A Survey Study Among Graduated Physician Assistants

Timo de Raad, Fraukje Wiersma, Luppo Kuilman, Olle Ten Cate

Research output: Contribution to journalArticleAcademicpeer-review


INTRODUCTION: Entrustable professional activities (EPAs) are used during training but may also have significance after graduation. This domain has not yet been much explored. We investigated the use of EPAs among alumni of Master Physician Assistant programs in the Netherlands, where EPAs have been used since 2010. We aim to describe if and how EPAs have a role after graduation. Are EPAs used for continuous entrustment decisions or when shifting work settings?

METHODS: In September 2020, all registered Dutch physician assistants (PAs) ( n = 1441) were invited to participate in a voluntary, anonymous survey focusing on the use of EPAs after graduation. Survey items included questions regarding the use and usefulness of EPAs, views on continuous entrustment decisions, and how PAs document their competence.

RESULTS: A total of 421 PAs (response rate 29%) yielded information about the significance of EPAs after training. Among the respondents, 60% ( n = 252) reported adding new competencies and skills after graduation. One-third ( n = 120) of the respondents were trained in EPA-based programs. Almost all EPA-trained PAs (96%; n = 103) considered the EPA structure suitable to maintain and renew entrustment. Furthermore, PAs reported continued use of the EPA framework to seek formal qualifications through entrustment decisions.

CONCLUSION: This study shows that EPAs can play an ongoing role for PAs after graduation. EPA-trained PAs overwhelmingly support the continuous use of the EPA framework for entrustment decisions from graduation until retirement.

Original languageEnglish
Pages (from-to)28-33
Number of pages6
JournalThe Journal of continuing education in the health professions
Issue number1
Publication statusPublished - 1 Jan 2023


  • humans
  • competency-based education
  • clinical competence
  • internship and residency
  • physician assistants
  • surveys and questionnaires


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