--- title: Why counting procedures no longer works – and what modern specialist training needs instead description: Modern specialty training needs more than numbers — discover how EPAs and preparedEPA foster lasting competence and objective clinical assessment. --- [![prepared logo](https://www.prepared.app/hs-fs/hubfs/Website/corp_transparent-1.png?width=178&height=50&name=corp_transparent-1.png) ![prepared Logo](https://www.prepared.app/hs-fs/hubfs/Website/corp_transparent-1.png?width=178&height=50&name=corp_transparent-1.png)](https://www.prepared.app?hsLang=en) [![prepared Logo](https://www.prepared.app/hs-fs/hubfs/Website/corp_transparent-1.png?width=178&height=50&name=corp_transparent-1.png)](https://www.prepared.app?hsLang=en) - [Home](https://www.prepared.app?hsLang=en) - [preparedEPA](https://www.prepared.app/epa?hsLang=en) - [Benefits](https://www.prepared.app/epa?hsLang=en#benefits) - [Existing Curricula](https://www.prepared.app/epa-based-curricula?hsLang=en) - [Pricing](https://www.prepared.app/pricing-preparedepa?hsLang=en) - [prepared360](https://www.prepared.app/360?hsLang=en) - EPA Campus - [About EPAs](https://www.prepared.app/en/cbme-blog/epas_einfach_erklaert?hsLang=en) - [CBME Blog](https://www.prepared.app/en/cbme-blog) - [Knowledge Base](https://www.prepared.app/resources?hsLang=en) - [42+4 Initiative](https://www.prepared.app/de/42plus4?hsLang=en) - [About us](https://www.prepared.app/about-us?hsLang=en) - [Careers](https://www.prepared.app/jobs?hsLang=en) - [Home](https://www.prepared.app?hsLang=en) - [preparedEPA](https://www.prepared.app/epa?hsLang=en) - [preparedEPA](https://www.prepared.app/epa?hsLang=en) - [Benefits](https://www.prepared.app/epa?hsLang=en#benefits) - [Existing Curricula](https://www.prepared.app/epa-based-curricula?hsLang=en) - [Pricing](https://www.prepared.app/pricing-preparedepa?hsLang=en) - [prepared360](https://www.prepared.app/360?hsLang=en) - EPA Campus - [About EPAs](https://www.prepared.app/en/cbme-blog/epas_einfach_erklaert?hsLang=en) - [CBME Blog](https://www.prepared.app/en/cbme-blog) - [Knowledge Base](https://www.prepared.app/resources?hsLang=en) - [42+4 Initiative](https://www.prepared.app/de/42plus4?hsLang=en) - [About us](https://www.prepared.app/about-us?hsLang=en) - [About us](https://www.prepared.app/about-us?hsLang=en) - [Careers](https://www.prepared.app/jobs?hsLang=en) [Contact us](https://www.prepared.app/prepared-demo?hsLang=en) - [English](https://www.prepared.app/en/cbme-blog/prozeduren-zaehlen-mit-op-katalog-reicht-nicht-mehr) - [German](https://www.prepared.app/de/cbme-blog/prozeduren-zaehlen-mit-op-katalog-reicht-nicht-mehr) - [EPA](https://www.prepared.app/en/cbme-blog/tag/epa) - [CBME](https://www.prepared.app/en/cbme-blog/tag/cbme) - [preparedEPA](https://www.prepared.app/en/cbme-blog/tag/preparedepa) - [CBE](https://www.prepared.app/en/cbme-blog/tag/cbe) - [WBA](https://www.prepared.app/en/cbme-blog/tag/wba) - [CBME](https://www.prepared.app/en/cbme-blog/tag/cbme) - [Clinic](https://www.prepared.app/en/cbme-blog/tag/clinic) - [EPAs](https://www.prepared.app/en/cbme-blog/tag/epas) - [Feedback](https://www.prepared.app/en/cbme-blog/tag/feedback) - [Feedback culture](https://www.prepared.app/en/cbme-blog/tag/feedback-culture) - [Growth Mindset](https://www.prepared.app/en/cbme-blog/tag/growth-mindset) - [Introducing WBA](https://www.prepared.app/en/cbme-blog/tag/introducing-wba) - [Level of supervision](https://www.prepared.app/en/cbme-blog/tag/level-of-supervision) - [Programmatic Assessments](https://www.prepared.app/en/cbme-blog/tag/programmatic-assessments) - [Psychological safety](https://www.prepared.app/en/cbme-blog/tag/psychological-safety) - [competency-based training](https://www.prepared.app/en/cbme-blog/tag/competency-based-training) - [ePortfolio](https://www.prepared.app/en/cbme-blog/tag/eportfolio) - [prepared360](https://www.prepared.app/en/cbme-blog/tag/prepared360) [EPA](https://www.prepared.app/en/cbme-blog/tag/epa) [CBME](https://www.prepared.app/en/cbme-blog/tag/cbme) # Why counting procedures no longer works – and what modern specialist training needs instead 26.09.2025, 10:45:00 ## The Illusion of Safety in Medical Training Most medical professionals are familiar with the checklists used during specialty training: proof of completed intubations, central venous catheters (CVC), or transesophageal echocardiographies (TEE). These logs create an illusion of safety — suggesting that merely counting procedures ensures competence and transparency in education. In practice, this routine approach rarely guarantees that trainees can actually perform these tasks independently and competently. --- ## The flaw in counting procedures Here lies the critical weakness: when documentation becomes a mere box-ticking exercise, the system loses its meaning. The European Society of Cardiology (ESC) demonstrated this in an analysis showing that more interventions were documented annually than there were patients treated. ![ChatGPT Image 5. Nov. 2025, 15_13_47](https://www.prepared.app/hs-fs/hubfs/ChatGPT%20Image%205.%20Nov.%202025%2c%2015_13_47.png?width=145&height=145&name=ChatGPT%20Image%205.%20Nov.%202025%2c%2015_13_47.png)These “fake numbers” are not unique to cardiology — they occur elsewhere too, for instance when multiple people are listed on an operative report even though they weren’t truly involved. The result: counting cases or years of training does **not** reflect real expertise and instead promotes inaccurate or even forced documentation. ## A paradigm shift: competency-based training with EPAs Today, **quality** counts more than quantity. Competency-Based Medical Education (CBME) focuses on **workplace-based assessments (WBAs)** and **Entrustable Professional Activities (EPAs)**. An EPA describes a professional task that a trainee may perform independently only after reaching a defined level of supervision. Competence emerges from the interplay of **knowledge, skill, and attitude**. Therefore, continuous, workplace-based evaluations are replacing the one-off “high-stakes exam” at the end of training. Over time, this approach builds a meaningful and trustworthy **competence profile**. ## How preparedEPA increases objectivity ![tom susan KSA](https://www.prepared.app/hs-fs/hubfs/tom%20susan%20KSA.jpg?width=203&height=99&name=tom%20susan%20KSA.jpg) preparedEPA replaces rigid checklists with **authentic, workplace-based assessments**. The focus is on assessing the level of supervision required for each EPA — not whether something was “right” or “wrong,” but how much support the trainee still needs. Two features make this approach particularly objective and context-sensitive: 1. **Distinguishing simple from complex cases:** The app records whether a given task (e.g., inserting an IV line) was simple or complex — as judged by both trainee and supervisor. 2. **Direct observation on site:** Supervision takes place where the work happens. Evaluations conducted weeks later are neither accurate nor meaningful. Recent master’s theses from the U.S. and Canada revealed an average delay of **31 days** between a clinical event and its assessment — an unacceptable gap. Instead of grading “good” or “bad,” the scale measures **how much supervision** is required — enabling a fairer and more nuanced evaluation of trainees. ## Conclusion: making competence visible instead of checking boxes Those who move away from counting procedures and toward **continuous, competency-based EPA assessment** gain a holistic and credible picture of professional growth. Countries such as the Netherlands have already replaced traditional board exams with structured EPA-based curricula. The path toward modern specialty training is **not** to wait for the perfect checklist — but to start now: with ongoing assessment, meaningful observation, and a strong culture of feedback Tags: [EPA,](https://www.prepared.app/en/cbme-blog/tag/epa) [CBME](https://www.prepared.app/en/cbme-blog/tag/cbme) Autor: **[Dr. Lukas Kandler](https://www.prepared.app/en/cbme-blog/author/dr-lukas-kandler)** 26.09.2025, 10:45:00 ## Related Articles [How to Make EPA Assessments Stick Dr. Adi Marty • 30.03.2026, 18:37:16](https://www.prepared.app/en/cbme-blog/epa-daily-routine?hsLang=en) [How a feedback culture creates a positive and effective learning environment prepared team • 19.09.2025, 22:22:01](https://www.prepared.app/en/cbme-blog/feedback-culture?hsLang=en) ![prepared Logo](https://www.prepared.app/hs-fs/hubfs/Website/corp_transparent-1.png?width=178&height=50&name=corp_transparent-1.png) - [Legal](https://www.prepared.app/legal) - [Investors](https://www.prepared.app/investors) - [Jobs](https://www.prepared.app/jobs) - [Contact](https://www.prepared.app/contact) ©2026 PrecisionED AG. 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