Teaching entrustable thinking in the flipped classroom
Date & Time
Sunday, June 13, 2021, 1:45 PM - 4:45 PM

This workshop will use a flipped classroom (FC) protocol to train participants how to use the FC method to teach the thinking required for performing the AAMC Core Entrustable Professional Activities for Entering Residency (EPAs).

EPA thinking is the decision-making process that underlies the clinical activities that all entering residents should be expected to perform on day 1 of residency without direct supervision. Our application is unique in that EPA thinking can be taught separately from EPA application. This can begin preferably in year 1 and extend into clerkship didactic time where it coincides with application. Teaching EPA thinking in advance of clinical training is feasible because it can be generalized during basic science courses to the self-directed, integrative thinking needed for Step 1. Learning EPA thinking relies heavily on a group learning environment to bring awareness of the difference between novice level pre-entrustable thinking and the more skilled entrustable thinking. Participants will learn a simple rubric for assessing the effectiveness of the group on 1) degree of engagement and 2) depth of integration.

The workshop exercises are based on experiences of the presenters utilizing content from both the first year of the curriculum and from the clerkship setting. Teaching EPA concepts in the preclinical years is based on the principle that while students cannot learn to apply EPA thinking without a clinician supervising, they can learn what EPA thinking is. For example, preclinical students can learn how pre-entrustable thinking is less developed and more rote than EPA thinking. The didactic material will compare characteristics of pre-entrustable and entrustable thinking to show that the thought process can be taught. The innovation introduced in this workshop is that EPA thinking can be taught prior to its application in the clinical setting.

We have modeled our workshop after the successful TBL 101 workshops that utilize the TBL method itself to train the participants. Our flipped classroom will resemble the group activities in the TBL method except that the elicitation of responses from the participants will bear a closer resemblance to attending rounds.

The participants will be emailed relevant information in advance to help them prepare for the workshop exercises although participants who have not been able to prepare in advance will also be accommodated. Each participant, with all reference materials available, will be asked to provide a rationale for their analysis of each answer choice in a series of selected multiple-choice questions. The questions are designed to create dialogue and engage group members in reaching consensus. The emphasis in teaching thinking is not on ability to remember concepts but in using concepts to present and discuss rationales. Participants will use a scoring rubric that rates whole group engagement and whole group integration of concepts. Compilation of experience will focus on developing awareness of the type of thinking employed by entrustable students.

Participants will be encouraged to join an EPA Thinking special interest group to communicate their ideas and experience with teaching EPA thinking. The special interest group will also be supported at the EPA Thinking Course webpage:

Participants will be able to conduct faculty development workshops at their own institution to introduce the EPA Thinking course along with application to any course where lectures have become a liability. When conducted in the manner that we recommend, this modality is productive, energizing, engaging, and intellectually satisfying.


  1. 15 min. Introduction of participants and brief history of presenter experience
  2. 15 min. Brief introduction to EPA concept (also covered in advance mailing).
  3. 15 min. Active exercise: TPS- how does learning style, thinking style impact group dynamics
  4. 20 min. Formation of groups and large group demo of flipped classroom. Subject will be answer choices for test on integrative thinking vs. recognition thinking; questions and clarification
  5. 40 min. FC small group exercise: EPA concepts years 1/2, resource materials mailed in advance and also provided at workshop
  6. 40 min. FC small group exercise: EPA/Step 2CK concepts years 3/4, resource materials mailed in advance and also provided at workshop
  7. 20 min. Compile experience from groups and general discussion; reactions to experience; clarification of strategy
  8. 15 min. Summary and offer to join an EPA Thinking special interest group through IAMSE listserv.

Dr. Pelley developed the concept of EPA Thinking an has a free access online course for institutions to teach the course at their institution. Several institutions have already communicated intentions to teach the course next year. He has developed a metacognitive program that teaches self-directed learning skills with free online access and his work has been recognized by the AOA Distinguished Teacher Award. Dr. Pelley's credentials include experience with PBL and TBL are available at his website

Dr. Babb has employed the flipped classroom for the didactic content of the Family Medicine clerkship and has presented his work over the past several years in conjunction with other institutions at the Society of Teachers of Family Medicine.

John Pelley