Entrustable professional activities (EPAs) have seen widespread adoption in medical education and other health professions education. EPAs aim to provide a bridge between competency-based education and clinical practice by translating competencies into fundamental profession-specific tasks associated with clinical practice. Despite the extensive use of EPAs in health professions education, EPAs have yet to be introduced into chiropractic education. The purpose of this paper is to describe the development and introduction of EPAs as part of 2 community-based chiropractic student preceptorship education programs in the United States.


EPAs were developed and introduced at 2 community-based chiropractic preceptorship sites in 5 distinct steps: (1) differentiating EPAs from competencies, learning objectives, and knowledge, skills, and attitudes; (2) identifying EPAs; (3) mapping EPAs to competencies and necessary experience, knowledge, and skills; (4) designing EPA assessment strategies; and (5) implementing the use of EPAs.


A total of 13 individual EPAs were developed and mapped to Council on Chiropractic Education meta-competency outcomes and underlying experience, knowledge, and skills. Three assessment tools were created to evaluate student entrustability for EPAs and enhance student self-assessment. The EPAs and assessment tools were integrated into chiropractic student preceptorships at each site.


This paper describes the development and introduction of EPAs at 2 community-based chiropractic preceptorship sites. Future research is needed to develop and standardize EPA use and assessment, and to evaluate outcomes associated with EPA use.

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Author notes

Kevin Mathers is the chiropractic section chief with the Veterans Affairs Pittsburgh Healthcare System and is an adjunct associate professor in the School of Health and Rehabilitation Sciences at the University of Pittsburgh (University Drive C, Pittsburgh, PA 15240; [email protected])

Jeff King is an associate professor in the Department of Neurosurgery at the Medical College of Wisconsin (1155 N. Mayfair Rd., Milwaukee, WI 53226; [email protected])

Michael Schneider is a Professor and Director of the Doctor of Chiropractic Program in the Department of Community Health Services and Rehabilitation Science at the University of Pittsburgh (100 Technology Dr, Suite 500, Pittsburgh, PA 15219; [email protected])

Michael Wiles is an adjunct professor in the School of Chiropractic at the Universidad Central del Caribe (PO Box 60327, Bayamón, Puerto Rico 00960; [email protected])

Author Contributions Concept development: JAG, KSM, JK, MJS, MRW. Design: JAG, KSM, JK, MJS, MRW. Writing: JAG. Critical review: JAG, KSM, JK, MJS, MRW.

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