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J Pain Symptom Manage. 2017 Jul 17. pii: S0885-3924(17)30266-X. doi: 10.1016/j.jpainsymman.2017.07.003. [Epub ahead of print]

Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States.

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Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA. Electronic address:
University of Alabama at Birmingham, Birmingham, AL, USA.
University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San, Diego, La Jolla, CA, USA.
Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
The Children's Hospital of Philadelphia., Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
University of Chicago, Chicago, IL, USA.
Marshfield Clinic, Marshfield, WI, USA.
Ethics Committee Chair, Summa Health / Northeast Ohio Medical University, Akron, OH, USA.
University of California San Diego/Scripps Health, Scripps Health San Diego, CA, USA.
Teaching & Learning Center Yale School of Medicine, Yale School of Medicine, New Haven, CT, USA.
Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.



Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be 'entrusted' to practice without supervision1. A physician workgroup of the American Academy of Hospice and Palliative Medicine (AAHPM) sought to define Hospice and Palliative Medicine (HPM) EPAs.


To describe the development of a set of consensus EPAs for HPM fellowship training in the United States.


A set of HPM EPAs was developed through an iterative consensus process involving an expert workgroup, vetting at a national meeting with HPM educators, and an electronic survey from a national registry of 3,550 HPM physicians. Vetting feedback was reviewed and survey data were statistically analyzed. Final EPA revisions followed from the multisource feedback.


Through the iterative consensus process, a set of 17 HPM EPAs was created, detailed, and revised. In the national survey, 362 HPM specialists responded (10%), including 58 of 126 fellowship program directors (46%). Respondents indicated the set of 17 EPAs well-represented the core activities of HPM physician practice (mean 4.72 on a 5-point Likert scale) and considered all EPAs to either be "essential" or "important" with none of the EPAs ranking "neither essential, nor important."


A set of 17 EPAs was developed using national input of practicing physicians & program directors and an iterative expert workgroup consensus process. The workgroup anticipates EPAs can assist fellowship directors with strengthening competency-based training curricula.


Entrustable Professional Activities; Fellowship; Graduate Medical Education; Hospice; Palliative Care

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