Entrustable professional activities as a training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot

ABSTRACT

In 2014, the Association of American Medical Colleges (AAMC) published 13 Core Entrustable Professional Activities (EPAs) that graduating students should be able to perform with indirect supervision when entering residency. A ten-school multi-year pilot was commissioned to test feasibility of implementing training and assessment of the AAMC’s 13 Core EPAs. In 2020–21, a case study was employed to describe pilot schools’ implementation experiences. Teams from nine of ten schools were interviewed to identify means and contexts of implementing EPAs and lessons learned. Audiotapes were transcribed then coded by investigators using conventional content analysis and a constant comparative method. Coded passages were organized in a database and analyzed for themes. Consensus among school teams regarding facilitators of EPA implementation included team commitment to piloting EPAs; agreement that: proximal EPA adoption with curriculum reform facilitates EPA implementation; EPAs ‘naturally fit’ in clerkships and provided opportunity for schools to reflect on and adjust curricula and assessments; and inter-school collaboration bolstered individual school progress. Schools did not make high-stakes decisions about student progress (e.g., promotion, graduation), yet EPA assessment results complemented other forms of assessment in providing students with robust formative feedback about their progress. Teams had varied perceptions of school capability to implement an EPA framework, influenced by various levels of dean involvement, willingness, and capability of schools to invest in data systems and provide other resources, strategic deployment of EPAs and assessments, and faculty buy-in. These factors affected varied pace of implementation. Teams agreed on the worthiness of piloting the Core EPAs, but substantial work is still needed to fully employ an EPA framework at the scale of entire classes of students with enough assessments per EPA and with required data validity/reliability. Recommendations stemming from findings may help inform further implementation efforts across other schools adopting or considering an EPA framework.

KEYWORDS:

• Entrustable Professional Activities
• Readiness for residency
• Work-based assessments
• Undergraduate medical education
• Multi-institution pilot

Acknowledgements

The authors wish to thank Alison Whelan MD, Chris Hanley, and Beatrice Schmider of the Association of American Medical Colleges (AAMC), and all the members of the Core Entrustable Professional Activities for Entering Residency Pilot, for their support, inspiration, and contributions to this case study. All participating Core EPA pilot institutions and individuals can be found at https://www.aamc.org/initiatives/coreepas/pilotparticipants/. We also wish to thank Jeremy Moeller MD, for his contribution to case study planning with reference to the phenomenon of entrustment.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The work was supported by the Association of American Medical Colleges