What is your level of confidence in performing each of the following Entrustable Professional Activities (EPAs)?

EPA-1  Gather a history and perform a physical examination:
        	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
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EPA-2  Prioritize a differential diagnosis following a clinical encounter:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-3  Recommend and interpret common diagnostic and screening tests:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-4  Enter and discuss orders and prescriptions:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
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EPA-5  Document a clinical encounter in the patient record:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-6  Provide an oral presentation of a clinical encounter:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-7  Form clinical questions and retrieve evidence to advance patient care:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-8  Give or receive a patient handover to transition care responsibility:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □

EPA-9  Collaborate as a member of an inter-professional team:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-10  Recognize a patient requiring urgent or emergent care and initiate evaluation and management: 
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-11  Obtain informed consent for tests and/or procedures:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-12  Perform general procedures of a physician:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □
EPA-13  Identify system failures and contribute to a culture of safety and improvement:
      	       Not at                   Slightly              Somewhat                                          Very
   	  All Confident  	      Confident            Confident             Confident         Confident
        	           □	        □               □                 □             □