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The rapid expansion of entrustable professional activity (EPA) assessment programs has led to calls to ensure fidelity in implementation and integrity in meeting the goals of competency-based medical education. Initiated in July 2017, in advance of the articulated core components of EPA implementation, this article describes the structure and outcomes of the University of Virginia (UVA) EPA Program and provides support for the identified essential components.The UVA EPA Program includes workplace assessments by residents/fellows, attending faculty, and master assessors (MAs), experienced clinicians who assess students across disciplines and clinical settings. All assessors participate in formal professional development and provide verbal and written comments to support their supervision ratings. The Entrustment Committee, composed of 12 MAs, uses a shared mental model and aggregates all assessor data to make a high-stakes summative entrustment decision about students' readiness to assume the role of an acting intern.Since 2017, over 2,000 assessors have completed 56,969 EPA assessments for 1,479 students. Ninety-four percent of assessments have been done during the clerkship phase. Residents/fellows have completed a mean of 18 assessments, attending faculty a mean of 27, and MAs a mean of 882. Seventy-four percent of observed encounters involved patients with acute concerns with or without a co-morbid condition. Fifty percent of assessments occurred in inpatient and 32% in ambulatory settings. Eighty-seven percent of assessments contained narrative comments with more than 100 characters.Planned next steps will include earlier identification of students who require individualized learning to promote the development of skills related to EPAs, expansion of the remediation program to enable more students to engage in a clinical performance mastery elective, and creation of targeted professional development for assessors to reinforce the tenets of the EPA program.

The United States is becoming increasingly diverse. Health disparities continue with little improvement despite national policies and standards. Medical institutions are modifying their curricula; however, little is known about faculty attitudes and comfort in addressing cultural issues. The purpose of this study was to determine faculty attitudes, self-perceived levels of comfort and skill, and future knowledge needs pertaining to cultural competence.A survey was administered to all clinical faculty at the University of Virginia School of Medicine. Survey questions addressed faculty attitudes and self-perceived levels of comfort and skill in dealing with cultural issues, as well as perceived need and interest in future cultural competence training.When considering each phase of education (medical school, residency, continuing medical education [CME]), fewer than 25% of the respondents reported receiving formal instruction in cultural competency in any given phase, although 93% felt that cultural competency training was important. Fifty-eight percent felt "very comfortable" caring for diverse patients, although this dropped to 30% when specifying limited English proficiency. The situation in which the highest percentage of respondents felt "not particularly comfortable" or "not at all comfortable" was breaking bad news to a patient's family first if this was more culturally appropriate (47%). Respondents felt most skilled in working with medical interpreters, apologizing for cross-cultural misunderstandings, and eliciting the patients' perspectives about their health and illness. Respondents felt the least skilled providing culturally sensitive end-of-life care and dealing with cross-cultural conflicts.Clinical faculty have received limited instruction on cultural competency, and the reported levels of comfort and skill in many challenging areas of multicultural health leave much room for improvement. Until faculty become more comfortable and are able to model and teach these behaviors to learners, positive responses to national policies in culturally competent care are likely to be limited.