Olle ten Cate

• PhD
• Professor (Full) at University Medical Center Utrecht

This letter emphasizes the need for context-specific Entrustable Professional Activities (EPAs) within Competency-Based Education (CBE) in health professions training. While EPAs in high-income countries often assess readiness for supervised residency, in many Global South regions—where postgraduate training is not always required—new graduates mus...

When health professions learners do not meet standards on assessments, educators need to share this information with the learners and determine next steps to improve their performance. Those conversations can be difficult, and educators may lack confidence or skill in holding them. For clinician-educators with experience sharing challenging news wi...

Although EPA assessment tools generally allow for narrative feedback, limited data exist defining characteristics and predictors of such feedback. We explored narrative feedback characteristics and their associations with entrustment, case-specific variables, and faculty/trainee characteristics. Our general surgery residency piloted an intraoperati...

In this article, the authors propose a repurposing of the concept of entrustment to help guide the use of artificial intelligence (AI) in health professions education (HPE). Entrustment can help identify and mitigate the risks of incorporating generative AI tools with limited transparency about their accuracy, source material, and disclosure of bia...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

This book discusses the ins and outs of a new approach to competency-based education in the education and training of health professionals, including doctors and medical specialists, but also nurses, dentists, pharmacists, veterinarians, physiotherapists and others. Embedded in a conceptual discussion of what competence in health professionals mean...

Introduction Training medical students requires objectives that are often translated into frameworks of competencies. Since the introduction of entrustable professional activities (EPAs), these tasks or ‘units of professional practice’, originally conceived for postgraduate training, define what residents must be prepared to do unsupervised. Nowada...

Purpose Medical training institutions worldwide must be prepared to remediate struggling learners, but there is little empirical evidence around learners' perspectives on remediation efforts. Research shows that emotion has a significant effect on learning, but it has not been well studied in remediation in medical education. Given the high stakes...

Purpose: With limited means, resource-deprived countries must find ways to organize education to meet standards. Few reports exist about anatomical education in LLMICs. This study explores how anatomy teaching is sustained in countries with few resources and which affordable educational strategies are applied to uphold quality. Methods: A mixed-...

In the United States, initial board certification remains focused on a high-stakes knowledge examination after completion of training. A more contemporary view supports a program of assessment that includes multiple types and sources of data with an emphasis on direct workplace observation to get the best picture of an individual’s performance. In...

Objective To provide an overview of the current use of Entrustable Professional Activities (EPAs) in postgraduate general surgery training internationally. Background Entrustable Professional Activities (EPAs) were introduced to connect clinical competencies and the professional activities to be entrusted to trainees on graduation. The popularity...

Introduction The Nominal Group Technique (NGT) is a consensus group method used to synthesize expert opinions. Given the global shift to virtual meetings, the extent to which researchers leveraged virtual platforms is unclear. This scoping review explores the use of the vNGT in healthcare research during the COVID-19 pandemic. Methods Following th...

Entrustable Professional Activities (EPAs) are an important tool to support individualisation of medical training in a competency-based setting and are increasingly implemented in the clinical speciality training for endocrinologist. This study aims to assess interrater agreement and factors that potentially impact EPA scores. Five known factors th...

The entrustment framework redirects assessment from considering only trainees’ competence to decision-making about their readiness to perform clinical tasks independently. Since trainees and supervisors both contribute to entrustment decisions, we examined the cognitive and affective factors that underly their negotiation of trust, and whether trai...

The widespread adoption of Competency-Based Medical Education (CBME) has resulted in a more explicit focus on learners’ abilities to effectively demonstrate achievement of the competencies required for safe and unsupervised practice. While CBME implementation has yielded many benefits, by focusing explicitly on what learners are doing, curricula ma...

This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development e...

Aim: To communicate how the Dutch postgraduate nursing education landscape was redesigned using entrustable professional activities (EPAs). The goal of this initiative was to reduce training time, enhance transfer across nursing specialities and contribute to a better-aligned continuum of initial education, postgraduate education and continuing pro...

Background: Entrustable professional activities (EPAs) were introduced across Dutch postgraduate programmes between 2017 and 2019. We aimed to understand the extent to which residents actually were granted increased clinical responsibility upon receiving summative entrustment for an EPA, a critical feature of its use. Methods: A survey study was...

La educación basada en competencias (EBC) o en resultados se ha difundido en todo el mundo en las últimas décadas. Las competencias son inferidas a partir de los desempeños observados de los estudiantes o residentes; esta observación provee las bases para que puedan ser evaluadas para asegurar que dichas competencias se han adquirido. Los currículo...

Objective Entrustable Professional Activities (EPAs) are an important tool to support individualization of medical training in a competency-based setting and are increasingly implemented in the clinical speciality training for endocrinologist. This study aims to assess interrater agreement and factors that potentially impact EPA scores. Design A ca...

The entrustment framework redirects assessment from considering only trainees’ competence to decision-making about their readiness to perform clinical tasks independently. Since trainees’ and supervisors’ viewpoints both contribute to entrustment decisions, we examined how they may differentially prioritize factors that determine trust, and how bia...

Background: The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for 'fixed standards' with 'flexible pathways', recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the...

Purpose The unprecedented influx of patients in 2020 with COVID-19 to intensive care units (ICU) required redeployment of healthcare professionals without adequate previous ICU-training. In these extraordinary circumstances, pivotal elements of effective clinical supervision emerged. This study sets out to explore the nature, aspects and key featur...

Entrustable Professional Activities (EPAs) and entrustment decision making are rapidly becoming mainstream in competency-based education in the health professions. EPAs are the units of professional practice to entrust graduates with once they have developed the required competencies. They were conceived to enable a gradual increase in professional...

Purpose Job competency frameworks are based on the listing skills required for a job. The assumption is that if a candidate is presumed to have the skills, then the candidate should be able to do the job. Thus, employers hope to identify prospective employees having the required skills. However, this may differ from knowing whether the employee is...

Unlabelled: Workplace-based interactions between residents and pharmacists, though relatively underexplored, might contribute substantially to learning. This international study sought to investigate the affordances residents use for informal learning about medications, their interactions with pharmacists and patterns of resident-pharmacist engage...

Phenomenon: Entrustable professional activities (EPAs) delineate major professional activities that an individual in a given specialty must be "entrusted" to perform, ultimately without supervision, to provide quality patient care. Until now, most EPA frameworks have been developed by professionals within the same specialty. As safe, effective, and...

Entrustable professional activities (EPAs), units of professional practice that require proficient integration of multiple competencies and can be entrusted to a sufficiently competent learner, are increasingly being used to define and inform curricula of health care professionals. The process of developing EPAs can be challenging and requires a de...

Introduction The competency-based medical education (CBME) movement continues to gain momentum in postgraduate physician training, resulting in increasing interest among surgical training programmes on how to implement it effectively. Entrustable professional activities (EPAs) were introduced to connect competencies (characteristics/abilities of le...

The history of medical education scholarship is often overlooked. Moreover, although productive educational researchers are often recognized for their scholarly contributions in peer-reviewed publications, the impact of others who are not active medical education researchers may be unknown to contemporary educators and scholars. This short paper de...

Background: Nurse-preceptors regularly struggle to evaluate students' readiness to take care of patients unsupervised, even with sophisticated workplace-based assessment tools. Preceptors' gut feelings are not always captured well, but are critical for judgement of readiness for learner entrustment with care tasks. Studies in medical education rep...

Healthcare has become highly specialized. Specialists, in medicine as well as in nursing, determine much of the high quality of current health care. But healthcare has also become increasingly fragmented, with professionals trained in separate postgraduate silos, with boundaries often difficult to cross. While a century ago, generalists dominated p...

With the rise of competency-based medical education and workplace-based assessment (WBA) since the turn of the century, much has been written about methods of assessment. Direct observation and other sources of information have become standard in many clinical programs. Entrustable professional activities (EPAs) have also become a central focus of...

Introduction Consensus group methods such as the Nominal Group Technique (NGT) and Delphi method are commonly used in research to elicit and synthesize expert opinions when evidence is lacking. Traditionally, the NGT involves a face-to-face interaction. However, due to the COVID-19 pandemic, many in-person meetings have moved to online settings. It...

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 EP...

Background Medical schools seek the best curricular designs for the transition to postgraduate education, such as the Dutch elective-based final, ‘transitional’ year. Most Dutch graduates work a mean of three years as a physician-not-in-training (PNIT) before entering residency training. To ease the transition to selected specialties and to decreas...

Background/purpose: Feedback processes in health professions education (HPE) are not always successful. While recommendations to improve feedback provision dominate the literature, studying specific learner attributes that impact feedback uptake may also improve feedback processes. Feedback orientation is a concept from management science involvin...

Health professions education (HPE) has matured into field of study that employs and produces specialized educational scholars. Many academic institutions employ such scholars to support development and innovation in education. Simultaneously, the possibilities to obtain a PhD degree in HPE are expanding. Clarity in the expectations that such a degr...

Entrustable professional activities: Towards standardization of language and meaning in Spanish and Portuguese Abstract The EPAs approach has had a great impact on medical education since it emerged in 2005. Its dissemination has required translation into several languages, sometimes generating terminological and meaning confusion. This paper is t...

Collaborative knowledge construction (KC) is an important process in interprofessional learning and a logical assessment target. A tool supporting the formative evaluation of KC behaviors ideally would be: 1) applicable to interprofessional teams of learners in clinical contexts; 2) informed by contemporary learning frameworks; 3) feasible and usef...

El enfoque de EPAs ha tenido un gran impacto en la educación médica desde que surgió en 2005. Su difusión a través de diferentes regiones del mundo ha requerido traducción a varios idiomas, y en algunas ocasiones ha generado confusiones terminológicas y de significado. Este artículo es el resultado de un consenso respecto de la traducción de términ...

Transitions within medical, veterinarian, and other health professional training, from classroom to workplace, between undergraduate, postgraduate, fellowship phases, and to unsupervised clinical practice, are often stressful. Endeavors to alleviate inadequate connections between phases have typically focused on preparation of learners for a next p...

Despite explanations in the literature, a returning question in the use of entrustable professional activities (EPAs) is how to distinguish them from competencies and skills. In this article, we attempt to analyze the causes of the frequent confusion and conflation of EPAs with competencies and skills, and argue why the distinction is important for...

Introduction: Entrustable professional activities (EPAs), discrete profession-specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programs. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary E...

This paper about Entrustable Professional Activities (EPAs) was solicited to support the discussion about the future of licensing within the Medical Council of Canada. EPAs, units of professional practice to be entrusted to learners or professionals once they have shown to possess sufficient competence, were proposed in 2005 to operationalize compe...

Recibido el 25 de octubre de 2021; aceptado el 15 de diciembre de 2021 PALABRAS CLAVE Educación médica de posgrado; Residencias médicas; Educación basada en competencias; Evaluación del aprendizaje; Evaluación del desempeño; Latinoamérica Resumen: El concepto de actividades profesionales a confiar surgió como un intento de superar las críticas al...

Resumen El concepto de actividades profesionales a confiar surgió como un intento de superar las críticas al enfoque de competencias, y ha tenido gran impacto tanto en la práctica como en la investigación de la educación en profesiones de la salud. A nivel internacional, se ha difundido por sus siglas en inglés: EPA (Entrustable Professional Activi...

The status of anatomy education in undergraduate medical education has dramatically changed over the course of the past century. From the most important and time-consuming component of the preclinical program, anatomy education has reduced in size and status, and yielded in curricular space to accommodate other disciplines and topics. Meanwhile, ra...

Dit hoofdstuk gaat over opleiden en leren in de zorg, met een focus op twee grote beroepsgroepen: verpleegkundigen en artsen. Hun opleidingen zijn dynamisch, anders dan twintig jaar geleden, en zeker anders dan een eeuw geleden, door nieuwe ontwikkelingen in de zorg, wetenschap, maatschappij en onderwijskundige inzichten. We schetsen het veranderen...

Purpose: To better prepare for potential future large-scale redeployments, this study examines quality of supervision and care as perceived by redeployed residents, fellows, and attendings during a COVID-19 surge. Method: During April and May 2020, attendings, fellows, and residents redeployed at 2 teaching hospitals were invited to participate...

Purpose There is a widely recognized need to improve teacher professional development as well as recognition of teaching expertise in health professions education (HPE). This study aimed to develop Entrustable Professional Activities (EPAs) for university teachers in HPE as foundations for systems of training, certification, and career opportunitie...

PhenomenonMedical learners are more likely than practicing physicians to experience negative emotions toward some patients whom they find challenging, and medical students experience such emotions related to their identity as learners. Little is known about experiences of residents, who are further along in their physician identity formation and ha...

Context Clinical supervisors make judgements about how much to trust learners with critical activities in patient care. Such decisions mediate trainees’ opportunities for learning and competency development and thus are a critical component of education. As educators apply entrustment frameworks to assessment, it is important to determine how narra...

To investigate to what extent the use of a three‐dimensional (3D) anatomy computer application can improve the acquisition of anatomical knowledge compared with anatomical atlases, junior and advanced medical students participated in an experiment. Participants were asked to answer anatomical questions with the use of a 3D anatomy application (deve...

The author was invited to write a commentary on the ethics of health professions education research. Based on the author’s own experiences, published guidelines, and discussions with international colleagues, the author found that research ethics can be roughly grouped into 3 distinct areas, each with its own distinct aims: protecting the integrity...

In the exceptional circumstances encountered during the COVID-19 pandemic, many ICUs were managed by a composite workforce of IC-certified and redeployed personnel. Although supervision is critical for safe care, supervisory roles were not clearly related to the amount of prior ICU experience. Vital for satisfaction with the quality of care was t...

Objectives Remediation can be crucial and high-stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion’s documented impacts on learning. Because this could present an important opportunity for improving remed...

To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and developmen...

Postgraduate medical education in the Netherlands has adopted competency-based education since the turn of the century. In 2006, the CanMEDS competency framework was introduced. A 2013 government plan to reduce the length and budgets of training programs led the Dutch Association of Medical Specialists (DAMS) to respond with a proposal to create mo...

Objective Medical Crew Resource Management (CRM) training courses are designed to increase patient safety by reducing the effects of human errors. These training courses are most popular in surgery and a wide range of medical CRM training courses for surgical teams is now available. However, the effects of these CRM training courses on patient outc...

The COVID-19 pandemic has disrupted many societal institutions, including health care and education. Although the pandemic’s impact was initially assumed to be temporary, there is growing conviction that medical education might change more permanently. The International Competency-based Medical Education (ICBME) collaborators, scholars devoted to i...

Competency-based medical education has been advocated as the future of medical education for nearly a half-century. Inherent to this is the promise that advancement and transitions in training would be defined by readiness to practice rather than by time. Of the logistical problems facing competency-based, time-variable (CBTV) training, enacting ti...

Health care revolves around trust. Patients are often in a position that gives them no other choice than to trust the people taking care of them. Educational programs thus have the responsibility to develop physicians who can be trusted to deliver safe and effective care, ultimately making a final decision to entrust trainees to graduate to unsuper...

With the rapid uptake of entrustable professional activties and entrustment decision-making as an approach in undergraduate and graduate education in medicine and other health professions, there is a risk of confusion in the use of new terminologies. The authors seek to clarify the use of many words related to the concept of entrustment, based on e...

Background China is experiencing major medical education reforms that include establishing national training standards, standards for health professionals, and advanced health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) with PhD programs to improve academic research and clin...

Purpose: Improved training for translational scientists is important to help address the waste of resources and irreproducibility of research outcomes in current translational medicine. However, there are a lack of training programs that cover the full range of knowledge and skills translational scientists need to develop, and many translational r...

Medical education, as a domain of scholarly pursuit, has enjoyed a remarkably rapid development in the past 70 years and is now more commonly known as health professions education (HPE) scholarship. Evidenced by a solid increase of publications, numbers of specialized journals, professional associations, national and international conferences, acad...

Background Bedside teaching (BST), a time‐honoured tradition of clinical teaching which integrates theoretical knowledge and clinical practice, has declined steeply over the last decade. Moreover, many clinician teachers today are not specifically trained in and/or comfortable in delivering effective BST. Resucitating this valuable educational form...

Entrustable professional activities (EPAs), as a focus of learner assessment, are supported by validity evidence. An EPA is a unit of professional practice requiring proficiency in multiple competencies simultaneously, that can be entrusted to a sufficiently competent learner. Taken collectively, a set of EPAs define and inform the curriculum of a...

Background and purpose This small study explores group identification among healthcare students. Identifying with a professional group serves professional identity formation. Social Identity Theory however shows how social identification with a group can result in negative attitudes towards ‘out-groups’, possibly other health professions. Method 2...

Entrustable Professional Activities (EPAs) are workplace responsibilities that directly impact patient care. The use of EPAs allows pharmacy faculty and preceptors to provide learners with feedback and assessment in the clinical setting. Because they focus assessment on a learner's execution of professional activities which requires integration of...

Background Due to the COVID‐19 pandemic, scientific congresses are increasingly being organised as virtual congresses. In May 2020, the European Academy of Neurology (EAN) held a VC, free‐of‐charge. In the absence of systematic studies on this topic, the aim of this study is to evaluate the attendance and perceived quality of the 2020 EAN virtual c...

Curricular integration represents collaborations between disciplines to establish a coherent curriculum and has become the dominant recommendation for medical education in the second half of the twentieth century. Vertical integration specifically is the integration between the clinical and basic science parts throughout the program. Vertically int...

Background This study explores the challenges clinical teachers face when first using a prospective entrustment-supervision (ES) scale in a curriculum based on Entrustable Professional Activities (EPAs). A prospective ES scale has the purpose to estimate at which level of supervision a student will be ready to perform an activity in subsequent enco...

Interprofessional education (IPE) and entrustable professional activities (EPAs) represent two topics in health professions education that have attracted significant attention in recent years. IPE (when different health professionals learn with, from and about each other with the aim of optimal care) has an inherent focus on the collective. EPAs (u...

Purpose: Research on how entrustment decisions are made identifies 5 broad influential factors (supervisor, trainee, supervisor-trainee relationship, context, task). However, this literature primarily represents the perspective of supervisors in graduate medical education and is conducted outside of an assessment framework where entrustment decisi...

Entrustable professional activities (EPAs) have received much attention in the literature since they were first proposed in 2005. Useful guidelines, workshops, courses, and conferences have supported faculty in developing programs and designing assessment procedures using EPAs and entrustment decision-making. Yet, the need for clarification remains...

The widespread use of telehealth, providing healthcare remotely, is hampered by various barriers. Dutch nurses currently working in practice never received education in this new way of healthcare delivery. Education is frequently suggested as a strategy to overcome barriers in telehealth use. However, the nature and effectiveness of such education...