Background Receiving feedback while in the clinical workplace is probably the most frequently voiced desire of students. In clinical learning environments, providing and seeking performance-relevant information is often difficult for both supervisors and students. The use of entrustable professional activities (EPAs) can help to improve student assessment within competency-based education. This study aimed to illustrate what students' perceptions are of meaningful feedback viewed as conducive in preparing for performing EPA unsupervised. Methods In a qualitative multicentre study we explored students' perceptions on meaningful feedback related to EPAs in the clinical workplace. Focus groups were conducted in three different healthcare institutes. Based on concepts from the literature, the transcripts were coded, iteratively reduced and displayed. Results Participants' preferences regarding meaningful feedback on EPAs were quite similar, irrespective of their institution or type of clerkship. Participants explicitly mentioned that feedback on EPAs could come from a variety of sources. Feedback must come from a credible, trustworthy supervisor who knows the student well, be delivered in a safe environment and stress both strengths and points for improvement. The feedback should be provided immediately after the observed activity and include instructions for follow-up. Students would appreciate feedback that refers to their ability to act unsupervised. Conclusion There is abundant literature on how feedback should be provided, and what factors influence how feedback is sought by students. This study showed that students who are training to perform an EPA unsupervised have clear ideas about how, when and from whom feedback should be delivered. Keywords Entrustable professional activities · Feedback · Competency based · Clinical workplace · Veterinary education · Medical education · Students · Focus group What this paper addsTo enhance the educational environment in the workplace, meaningful feedback and valid assessment of students are required. As the literature shows, it is difficult to successfully apply workplace-based assessments in clinical practice. The use of entrustable professional activities (EPAs) can help to improve student assessment within competencybased education. However, there still is little evidence about what students perceive as useful information to prepare for performing an EPA with less than full supervision. This study aimed to illustrate what students' perceptions are of meaningful feedback viewed as conducive to prepare for the performance of an EPA unsupervised Am I ready for it? Students' perceptions of meaningful feedback on entrustable professional activities 257

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IntroductionClinical training programs increasingly use entrustable professional activities (EPAs) as focus of assessment. However, questions remain about which information should ground decisions to trust learners. This qualitative study aimed to identify decision variables in the workplace that clinical teachers find relevant in the elaboration of the entrustment decision processes. The findings can substantiate entrustment decision-making in the clinical workplace.MethodsFocus groups were conducted with medical and veterinary clinical teachers, using the structured consensus method of the Nominal Group Technique to generate decision variables. A ranking was made based on a relevance score assigned by the clinical teachers to the different decision variables. Field notes, audio recordings and flip chart lists were analyzed and subsequently translated and, as a form of axial coding, merged into one list, combining the decision variables that were similar in their meaning.ResultsA list of 11 and 17 decision variables were acknowledged as relevant by the medical and veterinary teacher groups, respectively. The focus groups yielded 21 unique decision variables that were considered relevant to inform readiness to perform a clinical task on a designated level of supervision. The decision variables consisted of skills, generic qualities, characteristics, previous performance or other information. We were able to group the decision variables into five categories: ability, humility, integrity, reliability and adequate exposure.DiscussionTo entrust a learner to perform a task at a specific level of supervision, a supervisor needs information to support such a judgement. This trust cannot be credited on a single case at a single moment of assessment, but requires different variables and multiple sources of information. This study provides an overview of decision variables giving evidence to justify the multifactorial process of making an entrustment decision.

Introduction With the implementation of integrated curricula, less time is spent on teaching basic sciences to the benefit of subjects with more clinical relevance. Even though learning in a clinical context seems to benefit medical students, concerns have been raised about the level of (bio)medical knowledge students possess when they enter their rotations. This study aimed to obtain empirical data on the level of knowledge retention of second year medical students at the University Medical Center Utrecht, the Netherlands. Method A longitudinal study was performed in which second year medical students were retested for retention of first year knowledge by a study test consisting of questions from two course examinations of year 1, each with an interval of 8 to 10 months. Results were compared in a within-participants design.Results The results of 37 students were analysed. Students scored on average 75% (±8.2%) correct answers during the initial unit examinations and 42% (±8.8%) for the knowledge retention test. With correction for guessing this was 71% (±9.3%) versus 33% (± 9.9%), which means knowledge retention was on average 46%. Knowledge retention was higher for multiple choice questions (MCQs) (53%) versus nonMCQs (41%), and somewhat different for the two courses (53% and 40%). Conclusion After an interval of 8-10 months, more than half of first year knowledge cannot be reproduced. Medical students and faculty should be aware of this massive loss of knowledge and provide means to improve long-term retention.