Development and validation of entrustable professional activities (EPAs) for rheumatology training in Brazil: the Reuma-EPA project

BACKGROUND: Competency-based medical education increasingly guides postgraduate training worldwide. However, rheumatology training in Brazil still lacks a nationally standardized framework to define and assess core professional activities. Entrustable professional activities (EPAs) address this gap by translating competencies into observable clinical practice and supporting supervision, assessment, and progressive autonomy. OBJECTIVE: To develop and validate a national EPA framework for rheumatology training in Brazil and to present the conceptual and practical foundations supporting competency-based assessment in the specialty. METHODS: The Reuma-EPA project was conducted by the Education Committee of the Brazilian Society of Rheumatology using a five-phase methodological approach: identification of core professional activities, drafting of preliminary EPAs, internal expert review, internal consistency analysis, and national validation through a two-round Delphi process. Rheumatology educators from accredited residency programs across Brazil evaluated each EPA for relevance, clarity, and suitability for independent execution at the end of training. Consensus was defined as at least 80% of responses rated as 4 or 5 on a five-point Likert scale. RESULTS: Eleven EPAs were developed and validated, covering the full spectrum of rheumatology practice, including ethical and professional conduct, patient assessment, diagnostic reasoning, laboratory and imaging interpretation, outpatient and inpatient care, use of immunomodulatory therapies, procedural skills, patient safety, and education. Each EPA was mapped to supervision levels and developmental milestones, creating a comprehensive framework that integrates patient-safety considerations and suggested workplace-based assessment tools for Brazilian rheumatology training. CONCLUSION: The Reuma-EPA project establishes the first nationally validated EPA framework for rheumatology training in Brazil. By providing an actionable competency-based structure aligned with national regulatory standards, this initiative supports curricular harmonization, transparent assessment, and the progressive development of resident autonomy with patient safety as a central principle. This framework has the potential to strengthen rheumatology training nationally and may serve as a model for other specialties and healthcare systems.