Trainers’ and trainees’ expectations of entrustable professional activities (EPAs) in a primary care training programme

Figures & data

Table 1. topics used to facilitate focus group discussions.

Opening questions

How can the EPA method best be used in the context of Dutch GP training programme?

What are the advantages and disadvantages of the use of EPAs in the Dutch GP training programme?

Key questions

How can EPAs support the trainee’s learning process? How do EPAs aid in the identification of knowledge gaps? How do EPAs help in the creation of a personal learning agenda? What are advantages and disadvantages of using EPAs to support the trainee’s learning process?

How can EPAs help trainers evaluate their trainees? How can the EPAs be used to support an evaluation of the trainee’s progress in the various areas of competence? How do the EPAs help trainers to provide trainees with feedback? Can the EPAs provide support in the case of underperforming trainees? What are advantages and disadvantages of using EPAs to evaluate trainees?

Table 2. Demographic characteristics of the participants.

		GP trainers	Trainee GPs
Number of participants		15	34
Age (median (min-max)		50.0 (39.0–62.0)	29.0 (27.0–38.0)
Gender (N (%))
	Male	9 (60.0%)	6 (17.6%)
	Female	5 (33.3%)	28 (82.4%)
	Unknown	1 (6.7%)	0 (0.0%)

Table 3. quotes of participants.

Advantages of using EPAs
Quote (GP trainer): ‘Reading through them [EPAs], I see that they are all about situations. And situations can easily be recognised, which makes it very practical’.
Quote (Trainee GP): ‘They [EPAs] can help me to discuss my performance. I can ask my trainer: Why am I not performing well in that area?’
Disadvantages of using EPAs
Quote (GP trainer): ‘I do feel that many important things you experience in everyday practice are missing’.
Quote (GP trainer): ‘I wonder if we really want to use it [EPAs] as a checklist. I would rather leave it with the trainees, who could then use it [EPAs] to identify learning goals as well as any gaps in their own knowledge, and work from there’.
Application of EPAs in the training Programme
	EPAs as trainee learning tools
		Feed up
		Quote (GP trainer): ‘This is the essence of a GP’s profession, the end-product you have to deliver as a GP trainer. All the activities are precisely defined’.
		Quote (Trainee GP): ‘I know this list covers all of the important areas in our profession. It gives me peace of mind to know that I am not inadvertently being incompetent by forgetting to cover various vital aspects of the profession’.
		Feedback
		Quote (GP trainer): ‘I think you can also use them [EPAs] in a positive way, when a trainee is performing very well, for instance, you could say “That went very well, let’s take a look at the list of EPAs and see what you already know”’.
		Quote (Trainee GP): ‘A trainer often provides general feedback, such as “I’m happy with the way you’ve been performing lately”. But I think this [EPAs] can make your feedback much more specific, enabling trainers to say: “In the area covered by this topic, I would assess your performance as…”’.
		Feed forward
		Quote (GP trainer): ‘I have encountered this issue with one particular trainee who was ready to become a GP. This individual was looking for further challenges, and I can imagine that this list [of EPAs] could help in situations like that’.
		Quote (Trainee GP): ‘I like the way it works. You can focus on one specific subject for a certain period. Afterwards you can evaluate the period and your progress with your trainer’.
	EPAs for Trainers and training Practices
	Quote (GP trainer): ‘You can also use them [EPAs] to identify any shortcomings in training situations, thus helping trainees to understand what learning activities a specific training practice can and cannot offer them’.
	EPAs for curriculum design
	Quote (GP trainer): ‘And of course, how to set up a training programme, as it can be very useful to involve others in these programmes’.

Table 4. Proposed options for EPA use in the GP training programme.

Trainee learning Feed up: providing insight into training requirements Feedback: providing the trainee with targeted feedback on all aspects of their performance in the GP’s practice. Identifying existing expertise and any gaps in performance. Feed forward: writing a personal development plan, planning future internships. Providing high-performing trainees with challenges.

Trainer and training practice Identifying the trainer’s existing expertise and any gaps in their knowledge Identifying learning opportunities in training practice

Curriculum design for the GP training programme Adapting the GP training institute’s educational activities to the activities in the GP’s practice

Table

Theme	Emergency Care
EPA	Determines the condition of the patient using the ABCDE-system and performs necessary actions.
Description	Involves the urgency and the condition of the patient in clinical reasoning, rather than diagnosis-focused thinking.
	Identifies the reasons of acute need for care, including psychiatric and psychosocial crisis situations, frequently in unknown patients, without access to additional information.
	Identifies potentially life-threatening diseases and disorders, or rules them out; involves the differences in prevalence, incidence, and the a-priori probability of emergency cases in the GP-practice, the OOH-GP-centre, ambulance services and the emergence care department in this process.
	Handles emotions, fears and concerns in a professional manner, takes into account the safety of everyone involved in the situation.
Competence areas	Medical Expert, Communicator, Collaborator, Leader, Scholar