Designing the Future of Medical Education: The EPA Framework as a Catalyst to Inform Family Planning and Reproductive Health Fellowship Training Program in Ethiopia Medical Education: An Exploratory Sequential Mixed Method Study

Abstract

Introduction

Entrustable Professional Activities (EPAs) are tasks or responsibilities within a specific field that can be given to a learner once they are competent to perform them independently. EPAs are being used in various specialty programs and serving as valuable tool to inform educational program. However, due to disparities in professional practice between different contexts, the automatic transfer of a set of core EPAs is not feasible. Hence, our study aims to develop an EPA framework to inform the Family Planning and Reproductive Health Fellowship Program in the local context of Ethiopia.

Methods

We employed an exploratory mixed-method design, which involved the collection of qualitative data using the Nominal Group Technique and quantitative data through a nationwide survey in all residency training institutions across the country. Qualitative data analysis involved several steps, including compiling a list of tasks, removing duplicate tasks, reviewing EPAs using criteria and an equal rubric tool. For quantitative data analysis, descriptive statistics, validity index analysis, and intra-class correlation coefficients, were used.

Results

Seven senior panelists were able to propose a total of 57 EPAs, with 17 remaining after qualitative data analysis. The panelist evaluated the relevance of each EPA in the second phase. As a result, 17 EPAs received a content validity index of >0.83, indicating satisfactory relevance. In the national survey, experts reached a high level of final agreement regarding the relevance and representativeness of all 17 EPAs (ICC = 0.815, 95% CI [0.0.756,0.865], p.0001).

Conclusion

The final set of 17 end-of-training EPAs is valid, acceptable and representative of the discipline, and they can be used as a framework to inform Family planning and Reproductive Health Fellowship Program in Ethiopian medical education once these core EPA statements are described in sufficient detail. This can contribute to raise the quality of training and hence the quality of patient care.

Keywords:

• competencies
• competency-based education
• Ethiopia
• EPA
• reproductive health sub-specialty training

Abbreviations

CVI, Content Validity Index; EPA, Entrustable Professional Activities; FP, Family Planning; ICC, Intra-Class Correlation; I-CVI, Item-level Content Validity Index; NGT, Nominal Group Technique; Obs-Gyn, Obstetrics-Gynecology; RH, Reproductive Health; S-CVI, Scale level Content Validity Index; UA, Universal Agreement.

Data Sharing Statement

The article contains data that is supported by additional materials and referenced within the article.

Acknowledgments

We are very grateful to St. Paul Hospital Millennium Medical College for the ethical clearance. We express our gratitude to all the Ob-Gyn and FP/RH faculties that participated in this study. We appreciate their commitment to responding to our interviews. We would also like to thank the data collectors for their valuable contributions.

Author Contributions

All the authors have made significant contributions to the work being reported. This includes conception, study design, execution, data acquisition, analysis, and interpretation. They have also been involved in drafting, revising, and critically reviewing the article. Furthermore, they have given their final approval for the version to be published and have agreed on the journal to which the article has been submitted. The authors also accept responsibility for all aspects of the work.

Disclosure

The authors report that they have no conflicts of interest in this work.