ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAs) FROM CLINICAL TO BASIC SCIENCE DISCIPLINES: A METHODOLOGICAL PROPOSAL

Competence-based education has gained in popularity at many countries. Competence is regarded as the possession and development of integrated skills, knowledge, appropriate attitudes, and experience for the successful performance of ones life roles. A new concept is gaining great relevance in the clinic medical education context: Entrustable Professional Activities (EPAs) these activities allow curricular development of competencies, no longer in the classroom. EPAS have been identified for many graduate clinical education programmes, but none for basic sciences disciplines. With the idea of transfer EPA concept to the development and assessment of basic science competencies, this work offers: (1) a EPAS-competencies matrix to work the competency E2 described by the Association of American Medical College (linked with research skills) (2) the development of a complete EPA model. The proposal opens a line to discuss the implications and challenges that this concept-transfer offers.


Competency-based education (CBE):
CBE is not a novel educational model. It emerged towards the end of the 1960s, influenced by the educational objective taxonomy research of Bloom (Bloom et al., 1956) and the work developed by Mager in 1962 on instructional objectives (in Hardem, 2002). Recently, Competence-based education has gained in popularity and many countries, educational institutions and educational authorities are aiming to install ‗competence-based' education (Spencer & Spencer, 1993;Weinert, 2001;Van Dongen, 2003).A holistic approach of competence-based education is normatively put forward and competence is regarded as the possession and development of integrated skills, knowledge, appropriate attitudes and experience for the successful performance of one's life roles (Taylor, Popham, 1984, 1986, in McNamara, 1992Korthagen, 2004;Struyven& De Meyst, 2010). It has been stated that CBE is creating opportunities for students and workers, close to their world of experience in a meaningful learning environment (preferable the professional practice) wherein the learner can develop integrated, performance-oriented capabilities (knowledge structures and also cognitive, interactive, affective and where necessary psychomotor skills, and attitudes and values) for carrying out tasks and solving problems (Wesselink et al., 2003).

EPA concept:
A new concept is gaining great relevance in the clinic medical education context: Entrustuble Professional Activities (EPAs) (ten Cate et al., 2015; Chen et al., 2015; ten Cate et al., 2020). These activities allow curricular development of competencies, no longer in the classroom, with the application of competence-based education. The development of an EPA allows several competencies to be implemented simultaneously and are designed in such a way that they offer the student or trainee the opportunity to act and make decisions autonomously. The tutor supervises the activity with a higher or lower degree of intervention depending on the case, so that the evaluation is based on observation and collection of evidence through reports or portfolios that fill the learning, providing a feed-back of developed EPA. Therefore, the evaluation is based on what the evaluator "does" and not on what he would "do". EPAshave been identified for many graduate medical education programmes including paediatrics, obstetrics, internal medicine, family medicine and oncology between others

Proposal development:
As an example of the behavioral approach of the definition on competencies, the Association of American Medical College (AAMC, 2009) recognize Epstein and Hundert (2002) competence definition -the habitual and judicious of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection of daily practice for the benefit of the individual and the community being served‖ like most accepted in medical education. As it was stated before this approach consider that competencies are acquired through training, and development competence is based on the description of observable behavior or performance in situ (Mulder et al., 2007).
Based on this approach and definition of competence, this document mentions the global competencies that students should developed during basic undergraduate training in any itinerary of studies in health or life sciences. Among them, the Competency E2: -Demonstrate understanding of the process of scientific inquiry, and explain how scientific knowledge is discovered and validated‖, closely linked to the student's research skills (as a part of this competency) was selected as a starting point to develop this proposal. As the AAMC document established this competency is attached to some learning-outcomes: (1) Develop observational and interpretative skills through hands in laboratory or field experiences; (2) Demonstrate ability to measure with precision, accuracy and safety; (3) Be able to operate basic laboratory instrument for scientific measurement; (4) Be able to articulate scientific questions and hypotheses, design experiments, acquire data, perform data analyses and present results; (5) Demonstrate the ability to search effectively, to evaluate critically, and to communicate and analyze the scientific literature. The competency E2 is general, by definition and design, but if learning outcomes are expressed in terms of the level of competence to be obtained by the learner, they can be used like examples of roles or competencies domains to depth in the specificity of the competency, creating a framework with which educators can build educational programs. Curse-based projects, independent or summer research, community-based student research or laboratory research courses are some these experiences that provide students the opportunity to learn science by doing it (Sadler &Mckinney, 2010). Few biology departments can accommodate all students in pursuing authentic research projects, but for some of these methodological approaches the goal may not be creation of new knowledge but simply the development of the student as a scientist or the provision of opportunities to experience the process of science. In many cases, students in authentic research experiences can work in teams and contribute to obtain data to research publication. A strategy adopted for many professors is designed the activities around their personal research interests (AAAS, 2009). Related with this, it is very important to consider the role of professors as research mentors (Pfund et al., 2015) or supervisors of the trainees, positive mentoring has been cited as the most important factor in degree attainment (Solorzano, 1998) and also as improve retention students in academia (Ries et al., 2009).
Is in these experiences' context, that EPAs design and development, will gain meaning to cover the gap between theory and practice in basic science competencies and to offer an example of systematization of CBE in this area. So, with the idea of transfer EPA concept to the development and assessment of basic science competencies, this work offers: (1) a EPAs-competencies matrix to work global competency E2; (2) the development of a complete EPA model.

EPAS-Competencies matrix:
As ten Cate et al. (2015) propose a matrix using seven competencies domains or CanMED roles -developed by Frank (2005)-that are supposed to be integrated in the medical profession, to construct this matrix, we propose five roles/competencies domains (figure 1) linked to Competency E2 (what include research skills) described by the AAMC (2009). These roles are essential in the scientific training of health/life science undergraduate students to become a professional researcher or to build upon new scientific knowledge and critical thinking.
As EPAs can be considered discrete tasks that supervisors entrust a trainee with unsupervised once he has obtained adequate competencies, the matrix was constructed (figure 2) considering two main aspects: (1) the matrix should answer the question: which competencies must an individual possesses before a critical activity can be entrusted to this person to complete unsupervised? (2) matrix must provide an assessment guidance for both trainee and supervisor.  As it was mentioned before, EPAs development occurs at a workplace, the context in which most of the professional learning occurs (Ashton, 2004), connecting what trainees learn at the classroom and what they can apply once placed in real work (learning in situ). Taking this definition into account, a workplace in researcher's cases are different environments that include mainly Universities Departments, Hospitals laboratories, Research Centers and/or Research Enterprises Departments, were authentic activities and social interaction to learning take place (Collin, 2006).

Competency E2:
Demonstrate understanding of the process of scientific inquiry, and explain how scientific Knowledge is discovered and validated.  With this background exposed, between the EPAs proposed, EPA1 was selected to develop in depth like a model or example of EPA to competency-based education in the context of the basic sciences to develop competency E2 of the trainees (table 1). EPA1: Find relevant literature on a topic and be able to summarize and present the current state of knowledge (in particular: to write an article of revision).
The information and details included in the EPA example developed, follow the same scheme proposed by Chen et al. (2016) in the example of EPA to entry into clerkship.

. Specifications and limitations Specifications
The topic should be included in a supervising professor's real research project or a research line to be develop in the future. The trainee will be integrated in the research group to work with and exchange opinions and thoughts about the study subject (social interaction).

Limitations
The work must be developed in a period conditioned to the specific curriculum program. 3. Specific Knowledge, skills, and attitudes needed to execute the EPA well (curriculum reference depends on the specific program follow by the student) Knowledge: -able to properly selection of the topic (a little background and general Knowledge about the project or research line to be integrate in) Skills: -able to develop a manageable working plan -able to search properly bibliography -able to select correct documentary sources -able to access most important databases -able to analyze properly the information selected -able to synthesize information -able to put the ideas in order and write the article Attitudes: -able to enrich information with professional personal exchanges 4a. Link to supervising professor/senior researcher and research competencies -Linked to specific objectives of the supervising professor's research project or research line. -Linked to Competency E2 (see Figure 1): Demonstrate understanding of the process of scientific inquiry and explain how scientific Knowledge is discovered and validated.
-Specifically linked to E2.4 (see Figure 1) Trainee will be allowed without supervision to: 1. search information in data bases 2. analyze and do the selection of the main documental sources 3. put the ideas in order and write the outline of the article (without supervision but at this point professional exchange of opinions and reflections will be desired)

Final consideration:
As the new educational paradigm imposes (both in America and Europe) and with the main goal of ending the historical rift between science researchers and science educators and in the way to learn science doing science, both, scientifics and educators may work together to find out new methodological approaches to develop an authentic competence-based curriculum of health/live sciences undergraduate students. Ideally, an EPA briefly and meaningfully describes the main professional activities and is sufficiently general to be applicable in different contexts; EPA-concept should help to narrow a specialism down to independent professional activities without losing the holistic view of the profession (Van Loon et al., 2014). Focusing the interest especially in the enhance of the research abilities of the students, this work proposes to transfer de EPA-concept from de clinical sciences to the basic science to have a standard guideline for research mentors to follow and offer like an example, a EPAcompetencies matrix and complete EPA-model. The questions that would remain unresolved would be, when should a student -who wishes to be a researcher-be evaluated through these EPAs? How would an EPA-based curriculum for researchers be constructed? The proposal opens a line to discuss the implications and challenges that this concept-transfer offers to the improvement of the science research competences.