Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula

Abstract

Introduction Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula. Method For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. Results An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme. Discussion Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.

Co-designing Entrustable Professional Activities in General Practitioner’s Training: a Participatory Research Study

“…This optimization fosters a cohesive approach, ensuring high applicability rates and effectiveness, when the EPA framework is used in practice. The need for users' involvement in the development process is currently demonstrated in the most recent EPA literature [29,30]. Users' involvement promotes common language and expectations, enhancing the clarity and effectiveness of the EPA intervention, and, most importantly, empowers the users themselves by acknowledging their perspectives [31].…”

Comparison of OBGYN postgraduate curricula and assessment methods between Canada and the Netherlands: an auto-ethnographic study

“…For instance, potential applications of EPAs include assessing competence, making entrustment decisions for independent practice, facilitating professional development, and informing curriculum development. It is known that the uptake of EPAs in the curricula varies among the different specialty training programs ( 10 ).…”