Moving From Entrustability to Expertise Through Personalised Coaching and Productive Struggle

We read the article by Gallen et al. [1] with interest and share their view that current check-box competency assessments and entrustable professional activities (EPAs) are by themselves inadequate to adjudge clinical expertise (which some may call acumen). As the authors alluded to, these come through real-world experiences and iterative metacognitive/reflective practices on clinical decisions. However, we do not quite agree that competency and EPAs ought to be categorised in the same broad brush. The intent of EPAs, developed by Olle ten Cate, is to operationalise competencies in real-world clinical tasks—which means assessments are based on actual workplace observations of trainees' clinical decision-making [2]. Hosea Nyanavoli: writing – original draft. Jessele S. Y. Lai: writing – original draft. Isaac K. S. Ng: writing – original draft, writing – review and editing, supervision. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.