National EPAs of Family Medicine in Brazil

Caramori, Ugo; Cunha, Andrea Taborda Ribas da; Brito, Leonardo de Andrade Rodrigues; Pacheco, Rafaela Alves; Menezes, Rafaela Aprato; Pisco, Cassandra Renault; Freitas, Fernanda Lazzari; Lins, Mauro Magaldi; Caliço, Lívia Hinz; Zambom, Zeliete Linhares Leite

doi:10.1590/1981-5271v50.supl.1-20260143

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ORIGINAL ARTICLE • Rev. bras. educ. med. 50 (Suppl 1) • 2026 • https://doi.org/10.1590/1981-5271v50.supl.1-20260143.ING linkcopy

National EPAs of Family Medicine in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction: The development and validation of the National EPAs in Family Medicine (FM) serve as a strategy to enhance the quality of postgraduate training by identifying units of professional practice that clearly represent the specialty’s core identity and guide gradual entrustment decisions throughout residents’ training trajectories. This initiative addresses the complexity of Primary Health Care (PHC) and in-service training, both characterized by diverse curricula and difficulties in directly assessing clinical performance.

Objective: To describe the process of developing and validating the FM EPAs, presenting the resulting panel and its implications.

Method: The process adhered to international guidelines for EPAs development and validation. It involved creating a steering core group; using the nominal group technique for initial idea generation; refining the technical and descriptive aspects; evaluating the structure with the EQualRubric; and validating through the Delphi method, including calculating content validity indices, intraclass correlation coefficients, and analyzing qualitative data. All phases maintained regional diversity, professional representation, and methodological rigor.

Results: The initial stage produced 26 EPAs, later refined to 15 after technical review. The EQual Rubric analysis identified structural aspects needing improvement, which were incorporated before the next phase. In the Delphi study, with 45 participants, 14 EPAs reached consensus in the first round, while the remaining EPA was revised and validated in the second. Validity and reliability indicators demonstrated strong structural integrity, leading to a national panel of units of professional practice for the specialty.

Conclusion: The national FM EPAs represent a strategic advancement in training quality by enhancing curricular coherence, refining assessment processes, and strengthening educational governance. They serve as a foundational tool for aligning medical residency training with current PHC demands and the ethical and social commitments of the specialty.

Keywords:
competency-based education; family practice; medical residency

	Delimitation and Measurement	Essentiality and Reliability	Curricular Integration	Global EQual Rubric Score
EPA 1	3.3	3.75	4.35	3.92
EPA 2	3.61	4.22	4.26	3.97
EPA 3	3.85	4.26	4.36	4.11
EPA 4	3.78	4.29	4.22	4.05
EPA 5	4.4	4.51	4.56	4.48
EPA 6	4.45	4.6	4.6	4.53
EPA 7	4.9	4.17	4.82	4.67
EPA 8	4.73	4.37	4.6	4.59
EPA 9	4.15	4.1	4.2	4.15
EPA 10	4.5	4.55	4.7	4.57
EPA 11	4.15	4.15	4.42	4.22
EPA 12	4.55	4.7	4.67	4.62
EPA 13	4.31	4.45	4.47	4.4
EPA 14	3.98	4.2	4.42	4.17
EPA 15	3.58	3.65	4.03	3.78

	CVI-C	CVI-P	CVI-E	S-CVI/AVE	S-CVI/UA
EPA 1	80%	100%	100%	93.33%	74.07%
EPA 2	93.3%	93.3%	97.7%	94.76%	74.97%
EPA 3	91.1%	93.3%	97.7%	93.33%	79.27%
EPA 4	82.2%	97.7%	97.8%	92.56%	79.27%
EPA 5	86.6%	97.7%	97.8%	94.03%	86.57%
EPA 6	91.2%	100%	100%	97.06%	88.16%
EPA 7	91.2%	93.3%	93.3%	92.6%	79.26%
EPA 8	95.5%	100%	100%	98.5%	84.43%
EPA 9	88.9%	97.7%	95.6%	94.06%	76.3%
EPA 10	84.5%	100%	100%	94.84%	84.46%
EPA 11	95.6%	95.6%	97.8%	96.3%	88.16%
EPA 12	95.6%	93.4%	95.5%	94.83%	85.93%
EPA 13	91.1%	91.1%	97.8%	93.34%	82.2%
EPA 14	95.6%	97.8%	100%	97.8%	88.9%
EPA 15	94.6%	78.3%	72.9%	81.93%	59.83%

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Associação Brasileira de Educação Médica SCN - QD 02 - BL D - Torre A - Salas 1021 e 1023 , Asa Norte | CEP: 70712-903, Brasília | DF | Brasil, Tel.: (55 61) 3024-9978 / 3024-8013 - Brasília - DF - Brazil
E-mail: rbem.abem@gmail.com

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EPA 1	Providing comprehensive care across all ages and and life cycles	Entrusts the resident to provide comprehensive care across all ages and life cycles, conducting consultations, managing prevalent problems, promoting preventive actions, identifying situations of violence, and advocating for rights, ensuring comprehensive, safe, and person-centered care.
EPA 2	Proving care for individuals of of ethnicity, race, or culture similar to or distinct from one’s own	Entrusts the resident to provide care for individuals of different ethnicities, races, or cultures, considering diversity, assessing the impacts of racism on health, documenting cultural aspects, articulating intersectoral resources, and promoting anti-racist education, ensuring equitable and culturally sensitive care
EPA 3	Providing care for LGBTQIA+ individuals	Entrusts the resident to provide care for LGBTQIAPN+ individuals, addressing sexuality, managing specific conditions, identifying situations of violence, supporting body modification processes, and engaging support networks, ensuring inclusive care free from discrimination.
EPA 4	Providing care for individuals in situations of vulnerability	Entrusts the resident to provide care for individuals in situations of vulnerability, managing health problems in specific contexts, providing care to victims of violence, performing notifications, and articulating the intersectoral network, ensuring accessible, safe, and individually appropriate care.
EPA 5	Coordinating care based on the person’s needs	Entrusts the resident to coordinate care according to people’s needs, organizing clinical records, using management tools, supporting care transitions, and managing network resources, ensuring continuity, efficiency, and equity.
EPA 6	Providing home-based care	Entrusts the resident to provide home-based care, identifying eligibility, stratifying risk, coordinating teams, conducting visits and consultations, supporting support networks, and instructing caregivers, ensuring comprehensive, safe, and personalized care.
EPA 7	Performing outpatient procedures	Entrusts the resident to perform outpatient procedures, indicating and executing interventions, organizing the setting, obtaining consent, providing post-procedure follow-up, and managing complications, ensuring quality, safety, and respect for autonomy.
EPA 8	Providing initial care in urgent and emergency situations	Entrusts the resident to conduct initial care for urgencies and emergencies, organizing resources, performing risk classification, providing basic life support, and referring appropriately, ensuring prompt, effective, and coordinated responses.
EPA 9	Facilitating educational processes in Family Medicine for peers and other learners	Entrusts the resident to facilitate educational processes in Family Medicine, seeking scientific evidence, designing educational strategies, applying learner-centered methodologies, and fostering qualified teaching environments, ensuring continuous and collaborative learning.
EPA 10	Providing care for individuals affected by mental disorders	Entrusts the resident to provide care for individuals with mental disorders, performing clinical examinations, formulating differential diagnoses, using psychotropic medications and non-pharmacological interventions, managing psychiatric emergencies, and articulating the care network, ensuring comprehensive, safe, and evidence-based care.
EPA 11	Organizing health work processes	Entrusts the resident to organize health work processes, developing epidemiological surveillance, managing care workflows, strengthening interprofessional work, and promoting continuing education, ensuring efficiency, collaboration, and quality of care.
EPA 12	Applying the family approach in the care of individuals and their families	Entrusts the resident to apply the family approach, using diagnostic and interventional tools, conducting family interviews and conferences, and articulating care within the context of relationships, ensuring care centered on the family system.
EPA 13	Applying the community approach in the care of individuals, families, and communities	Entrusts the resident to apply the community approach, performing territorialization, situational diagnosis, mobilization of local resources, popular education, and group facilitation, ensuring care aligned with collective needs.
EPA 14	Promoting access and continuity of care	Entrusts the resident to promote access and continuity of care, reducing barriers to care, using technologies to expand access, stratifying risk, organizing schedules, and performing active outreach, ensuring equity and resolutiveness.
EPA 15	Promoting planetary health in one’s context	Entrusts the resident to promote planetary health, assessing socio-ecological impacts, managing conditions related to environmental crises, planning mitigation actions, and participating in intersectoral initiatives, ensuring commitment to sustainability and global health