Entrustable professional activities, entrustment, and the conceptualization of competence in the health professions
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
The use of entrustable professional activities (EPAs) and entrustment decision-making in health professional education was proposed to operationalize competency-based education. To ground its use, a common conceptualization of ‘competence’ is needed. Based on theoretical notions of epistemology (distinguishing propositional, procedural, and experiential knowledge) and inspired by the theoretical insights of Vygotsky, Maslow, Billett, and others, the authors elaborate a three-layered model that includes canonical competence (what every professional should have mastered, independent of context), contextual competence (the ability to work in relevant contexts and apply canonical competence), and personalized competence (the individual approach to high-level practice). The model aligns well with curricula that stress knowing, doing, and being, combining competency-based standards with professional identity formation. EPAs and entrustment decision-making typically regard the contextual layer of competence. This is because entrustment decisions, to support trainees in their progressive, professional autonomy, happen in clinical contexts where canonical, context-independent knowledge and skill are necessary but insufficient. Passing the threshold of entrustment with clinical responsibilities draws on both canonical competence and the ability to work in clinical contexts, responding to the needs of patients, of collaborators, and working within the rules and habits of the local environment. Once a trainee is entrusted with clinical responsibilities, and feels confident about the first two layers of competence, personalized competence can emerge more prominently, leading to integrated professional and personal identity formation. The three layers of competence together establish the conditions to think, act, and feel like a health professional: the knowing, the acting, and the being.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it