Entrustable professional activities, entrustment, and the conceptualization of competence in the health professions

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.