Entrustable Professional Activities (EPAs) are defined as a process of gradually entrusting key tasks to specialty fellows during their training. EPAs are an important component of competency-based medical education; the concept of entrustment is also familiar and intuitive to clinical faculty, even inexperienced evaluators even if not termed as such. In this paper, we describe the process of how the authors adopted an established EPA framework for gastroenterology training, using EPAs to guide curriculum and faculty development and assessment in ten steps: (1) adopting an established framework, (2) mapping EPAs to relevant competencies, (3) specifying expected behaviors for competency of each EPA, (4) training faculty and fellows to have a shared mental model, (5) designing the training curriculum and educational strategies based on EPAs, (6) determining the assessment strategy, (7) designing the assessment tool, (8) ensuring clarity in how assessment data are used to make summative decisions, (9) changing feedback culture of fellows, and (10) using a longitudinal coaching system to improve EPA performance.
