Defining Entrustable Professional Activities for Geriatric Dentists

We are using Entrustable Professional Activities (EPAs) because they describe real, observable tasks that a dentist must be trusted to perform independently. EPAs make the work visible, support accreditation, guide curriculum design, and help demonstrate why geriatric dentistry requires training beyond general dentistry.

We began with a national scoping review to understand what geriatric dentists actually do in real practice. This helped us identify the full range of clinical, ethical, and system‑navigation tasks that are not captured in current competency lists.

Delphi Round 1 tested the clarity and relevance of the four EPA domains. The panel strongly agreed that the domains were appropriate for specialty‑level practice. All existing activities met consensus for inclusion, though public‑health–related tasks were viewed as slightly less central to daily clinical care.

Round 1 comments highlighted important gaps in the current framework, including caregiver‑dependent care, cross‑setting care coordination, complex behavioral management, medical co‑management, legal/ethical responsibilities, and preventive/maintenance‑focused workflows.

Delphi Round 2 evaluated nine new proposed activities to determine whether each one was distinct, important, and should be included in the final EPA set. All items were rated highly important, but distinctiveness varied — showing that panelists differentiate between “important to do” and “important enough to stand alone.”

Five activities reached full consensus, including polypharmacy risk coordination, capacity assessment, elder abuse reporting, and communication of treatment modifications. Others were important but not clearly distinct enough to stand alone, such as medical clearances, integrated care planning, nutrition counseling, and public‑health surveillance.

Psychometric testing showed that the original four‑domain model did not hold statistically, with some domains merging and others lacking a clear identity. This raised important questions about how to structure the specialty in a way that is teachable, assessable, and defensible to accrediting bodies.

Our expert panel is now working to finalize a clear, defensible EPA framework that demonstrates the unique scope of geriatric dentistry, supports accreditation and training standards, and strengthens the case that this work cannot be fully performed by a general dentist without additional specialty preparation.

A Delphi study is a way to gather expert opinions and reach agreement on a topic through a series of surveys. Instead of meeting in person, experts answer questions online in multiple rounds. After each round, the responses are summarized and shared back with the group, so participants can see what others think and adjust their answers if they want. This process continues until the group reaches a clear level of agreement, or “consensus,” on the key issues. It’s useful for complex topics where there isn’t one right answer, like setting standards or defining best practices.

Entrustable Professional Activities (EPAs) are important because they turn broad skills into clear, real-world tasks that dentists must be trusted to perform safely and independently. Caring for older adults often involves complex medical conditions, multiple medications, and challenges like frailty or cognitive decline. EPAs help ensure that dentists are prepared for these situations by setting clear expectations for what they can do without supervision. This makes training more practical, improves patient safety, and supports consistent, high-quality care for older adults.

The surveys will include people with experience or interest in caring for older adults. This means dentists who treat older patients, dental educators and researchers, and other health professionals like nurses and physicians who work with aging populations. It will also include caregivers, older adults themselves, and advocates who support oral health or elder care. These three groups of participants (Dental professionals, medical professionals, and older adults or caregivers) bring different perspectives so the group can agree on what skills and tasks are most important for dentists working with older adults.

By taking part in this study, you will help shape what skills and tasks are most important for dentists who care for older adults. We are not looking for everyone to agree right away—your unique perspective matters. Differences in opinion help us understand where there is uncertainty and where more discussion is needed. Sharing your honest views will make the final recommendations stronger and more inclusive, so they reflect the real-world needs of patients, caregivers, and professionals.