A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018

Abstract

Purpose This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. Method Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6–41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency‐based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6–32). Conclusions This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.

Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities

“…11,[17][18][19][20][21][22][23][24] There is limited but promising evidence that EPAs can be used to assess trainees and make advancement decisions on a small scale in both undergraduate medical education and GME. [25][26][27][28][29][30] However, it is unknown whether EPAs can be implemented on a large scale in diverse clinical training environments to measure the progress of trainees over time or be used to make summative, end-of-training decisions about readiness to practice outside of a training environment. 25,[31][32][33] Filling this gap is important given the potential of EPAs to serve as a CBME framework that is intuitive to trainees and assessors and could guide curricula and assessment across the continuum of medical education to produce physicians who better meet the needs of society.…”

Assessment methods in medical specialist assessments in the DACH region – overview, critical examination and recommendations for further development

“…Examinations should be competence-based [11]. Currently, so-called EPAs (Entrustable Professional Activities) are increasingly being used to support curriculum development and test new ways of competence-based learning and testing [51]. Such a professional activity (EPA) could be, for example, the identification of an emergency patient on a normal ward and the initial assessment and initiation of necessary medical measures.…”

“…A special feature of the EPA approach is the assessment of the learner on the basis of the presumed need for supervision (“entrustment”). The use of EPAs is often intuitively attractive for clinically active physicians, but their potential, including existing challenges (see also literature on workplace-based assessments [51], must be further investigated before the replacement of quality-assured summative specialist examinations could be considered. …”

Introducing a clerkship curriculum based on entrustable professional activities: a pilot study

“…However, there is currently only limited evidence available on how to introduce and work with EPAs in clinical rotations, such as clerkships. While there has been attention to implementing EPA-based curricula from a general health professions and graduate medical education perspective, little attention has been paid to general quality criteria of clerkships after introducing EPAs [2,3].…”