Entrustable Professional Activities and Learning: The Postgraduate Trainee Perspective

Abstract

Objective Entrustable professional activities (EPAs) are used as clinical activities in postgraduate psychiatry training in Australasia. This study aimed to explore psychiatry trainees’ perceptions of the impact of EPAs on their motivation and learning. Methods A constructivist grounded theory approach was used to conceptualize the impact of EPAs on trainees’ motivation and learning. A purposive sample of trainees was recruited from across New Zealand. Semi-structured individual interviews were used for data collection and continued until theoretical saturation was reached. Results The impact of EPAs on learning was mediated by the trainee’s appraisals of subjective control, value, and the costs of engaging with EPAs. When appraisals were positive, EPAs encouraged a focus on particular learning needs and structured learning with the supervisor. However, when appraisals were negative, EPAs encouraged a superficial approach to learning. Trainee appraisals and their subsequent impact on motivation and learning were most affected by EPA granularity, alignment of EPAs with clinical practice, and the supervisor’s conscientiousness in their approach to EPAs. Conclusions To stimulate learning, EPAs must be valued by both trainees and supervisors as constituting a coherent work-based curriculum that encompasses the key fellowship competencies. If EPAs are to be effective as clinical tasks for learning, ongoing faculty development must be the leading priority.

Trainee doctors' preparedness for clinical work in geriatric psychiatry: A survey on 18 preliminary entrustable professional activities

“…This finding corroborates other researchers' conclusion that capacity assessment warrants greater emphasis in undergraduate medical education 40 . While good curriculum development (junior doctor training) can ensure or improve constructive alignment for all EPAs, 7 the alignment of objectives, teaching methods, and assessments should especially be further investigated and improved for EPAs 6 (capacity assessment), 7 (neurocognitive disorder), and 18 (interdisciplinary team rapports). EPAs 9, 10, 13, and 14 are apparently not performed in all teaching hospitals we surveyed.…”

“…Constructive alignment describes the alignment of learning objectives, teaching methods, and assessments regarding content and methods 6 . EPAs are well‐suited to improve constructive alignment in clinical learning environments by focusing on the actual tasks that trainees need to master in the workplace 7 …”

“…6 EPAs are well-suited to improve constructive alignment in clinical learning environments by focusing on the actual tasks that trainees need to master in the workplace. 7 A systematic review of EPAs in psychiatry identified several studies focusing on graduate training in psychiatry that primarily concerned the development, assessment, and implementation of EPAs. However, no study has been performed regarding the perceived preparedness for EPAs in geriatric psychiatry.…”

How well do UK assistantships equip medical students for graduate practice? Think EPAs

“…Synergy in understanding what constitutes important EPAs appears to trigger access to EPAs at an appropriate level of supervision. Engagement is dependent on context and relevant context includes placements that provide a legitimate role in the team providing access to relevant duties, supervisors attitude to actively engage student in EPAs (Stephan et al, 2023 ) and the supervisor-student relationship that must support a student’s sense of agency to ensure appropriate level of supervision (Caro Monroig et al, 2021 ). Assistantship placement can enhance this process if the curriculum explicitly validates learning in the clinical context and frees students to do so rather than appearing to focus on knowledge acquisition and testing (Crossley & Vivekananda-Schmidt, 2015 ).…”