From theory to practice – Olle ten Cate’s ideas took the world by storm
With his EPA concept, Professor Olle ten Cate has transformed medical education around the world. In recognition of his work, he was awarded the 2026 Karolinska Institutet Prize for Research in Medical Education (KIPRIME). But his path into medical education was far from obvious.
KIPRIME is an international award that recognises outstanding research in the field of medical education. Through his work, this year’s recipient, Olle ten Cate, professor emeritus at Utrecht University, has reshaped how we think about medical skills. He received the award at the professorial installation ceremony at KI in October.
Ten EPAs in Sweden
Olle ten Cate is considered the father of Entrustable Professional Activities (EPAs), a new educational concept for assessing students’ clinical skills. Five years have now passed since a model comprising ten national EPAs was introduced in Swedish medical programmes.
Rather than students being graded on their skills and knowledge, the role of the supervisor is to assess the degree of supervision each student needs and decide when they are ready to perform a clinical activity, or EPA, unaided – that is, when they can be entrusted with the task without supervision.
Such a task could involve taking a patient’s medical history or drawing up a treatment plan.
“If you have detailed knowledge but are unable to perform a clinical task in practice, what does that knowledge really mean?” he says.
Olle ten Cate began to think along these lines in the early 2000s, when he was a newly appointed professor at Utrecht University and served as a consultant for the national specialist training programmes for doctors.
Inspired by a Canadian competency-model called CanMEDS, which describes seven key roles that medical doctors need to develop to provide high-quality patient care, he wanted to find a more useful way to evaluate trainees’ clinical skills.
An idea that spread around the world
He published his first paper on the EPA concept in 2005, focusing on readiness for entrustment with clinical tasks. The response was slow in coming, but after a few years the article began to be cited more frequently.
Things really took off when Olle ten Cate and a colleague published another paper investigating how EPAs could be implemented in gynaecology and obstetrics. Today, EPAs are used in medical programmes around the world, and have also been adopted by other healthcare disciplines, such as nursing and dentistry.
Olle ten Cate believes that the concept has had such an impact because it is intuitive and easy to understand. For instance, it is easier to decide if a student is ready to be entrusted with a task than to assign a grade to how professional he or she is on a 9-point scale.
At the same time, Olle ten Cate stresses that the widespread use of the concept does not automatically mean that it is being used correctly. Even if many scientific papers have been written on the implementation, more research is still needed.
One challenge is the duration of the clinical placements. A central part of the EPA concept is that students are guided by supervisors and given increasing responsibility as their skills develop. Knowing the student well enough is important. That needs time.
“Since different people develop at different speeds, the training period must also be flexible,” he says. “For some, this might mean longer clinical placements and more supervision time.”
Another important achievement is Olle ten Cate’s work in establishing international networks and creating the International Medical Educators Exchange Programme (IMEX), a programme in which lecturers at medical universities visit each other to gain inspiration and exchange ideas.
International exchanges
Olle ten Cate intends to use his KIPRIME award to set up a foundation that, among other things, will support IMEX participants from low-income countries. He has also developed a four-day online course on the EPA concept that is available in different languages and will now be offered by the foundation.
In hindsight, it was far from certain that Olle ten Cate would devote his career to medical education. As a young medical student in the 1970s, he was concerned about the lack of educational evaluation in his own study programme. He surveyed his fellow students, compiled the results and submitted his findings to the medical faculty board.
Unexpected route to research
During a break from his studies, he took a part-time job as medical education developer at his university. He was hooked right away, never looked back, and was appointed professor of medical education at Utrecht University in 1999.
KIPRIME recognises a long research career, and even though Olle ten Cate is now professor emeritus, he does not see the award as marking the end of his career.
“I consider KIPRIME to be the highest honour that you can get in medical education,” he says. “But I also see it as an obligation. If you're in a high position, you have a responsibility to use it in the right way. It motivates me to keep thinking and developing new initiatives,” he says.
Text: Karin Tideström
Translation: Neil Betteridge