An update on current EPAs in graduate medical education: A scoping review

Figures & data

Table 1. Study eligibility criteria

Inclusion criteria	The following articles were included: ·Written in English ·Published during 2019–2020 ·Focuses on the implementation and/or assessment of EPAs ·Target on postgraduate physicians
Exclusion criteria	The following articles were excluded: ·Non‐English articles ·Focus of the article is not on the EPAs per se (e.g., milestones, capabilities) ·Subject is physician in other healthcare professionals (i.e., a nurse) or a physician not in the postgraduate stage ·Absence of original data regarding the implementation or assessment of EPAs

Figure 1. Scoping review process

Table 2. General characteristics of eligible studies

Characteristics	No. (%)	References
Study location
USA	19(65.5)	[14–17–19–21–23–24–26–30–32–34–36–39]
Canada	3(10.3)	[18,37,40]
India	2(6.8)	[22,31^]
Netherlands	2(6.8)	[25,38^]
Australia	1(3.4)	[^6]
Ireland	1(3.4)	[^13]
Germany	1(3.4)	[33]
Specialty
Surgery	7(24.1)	[16–21–23–24–34–36^]
Pediatric	5(17.2)	[14,17,25,30,39^]
Internal medicine	3(13.8)	[15,20,28^]
Community medicine	2(6.8)	[6,22]
Medical Oncology	2(6.8)	[37,40]
Otorhinolaryngology	1(3.4)	[31]
Radiology	1(3.4)	[38]
Dentistry	1(3.4)	[32]
Emergency medicine	1(3.4)	[18]
Physical Medicine and Rehabilitation	1(3.4)	[19]
Anesthesiology	1(3.4)	[13]
Pathology	1(3.4)	[27]
Psychiatry	1(3.4)	[26]
Multiple specialties	2(6.8)	[29,33]
Grade of physicians
Residents	20(68.9)	[16–18–21–23–27–30–31–33–40^]
Interns	4(13.8)	[14,15,28,29]
Physicians	2(6.8)	[6,13]
Fellows	1(3.4)	[17]
Not specified	2(6.8)	[22,32^]
Research purpose
Verify the reliability and validity of EPAs (including framework, tools, app, instruments, system, curriculums)	16(55.2)	[6–15–19–22–27–32–34–35–37]
Present practices of EPAs implementation	11(37.9)	[14,15,20,21,24,25,28,30,31,35,40^]
Survey on EPAs experience of related personnel	6(20.6)	[13,25,29,33,36,39^]
Gather information about factors and barriers affecting EPAs’ implementation	5(17.2)	[26–36–39^]
·Percentages do not sum to 100%, as one study may report more than one purpose

Figure 2. Common ways to implement or assess EPAs in GME

Stoneham E, Witt L, Paterson Q, et al. The development of entrustable professional activities reference cards to support the implementation of competence by design in emergency medicine. Can J Emerg Med. 2019;21:803–806.

 Web of Science ®Google Scholar

Page No:7 Tomiak A, Braund H, Egan R, et al. Exploring how the new entrustable professional activity assessment tools affect the quality of feedback given to medical oncology residents. J Canc Educ. 2020;35:165–177.

 PubMed Web of Science ®Google Scholar

Tomiak A, Linford G, McDonald M, et al. Implementation of competency-based medical education in a Canadian medical oncology training program: a first year retrospective review. J Canc Educ. Published online: October 27,2020. . DOI:https://doi.org/10.1007/s13187-020-01895-y

 Google Scholar

Shrivastava SR, Chacko TV, Bhandary S, et al. Development, validation and use of appropriate assessment tools for certification of entrustable professional activities in community medicine to produce a competent postgraduate: a pilot study. Indian J Public Health. 2019;63:277–281.

 Web of Science ®Google Scholar

Karthikeyan P, Pulimoottil DT. Design and implementation of competency based postgraduate medical education in otorhinolaryngology: the pilot experience in India. Indian J Otolaryngol Head Neck Surg. 2019;71:671–678.

 PubMed Web of Science ®Google Scholar

Smit MP, Hoog MD, Brackel H, et al. A national process to enhance the validity of entrustment decisions for Dutch pediatric residents. J Grad Med Educ. 2019;11:158–164.

 PubMedGoogle Scholar

Riezebos J, Van Der Zee DJ, Pruim J Entrustable Professional Activities in Residency Programs: planning and scheduling issues. Paper presented at Fifth International Conference on Higher Education Advances; 2019. p. 891–899. DOI:https://doi.org/10.4995/HEAd19.2019.9274

 Google Scholar

Valentine N, Wignes J, Benson J, et al. Entrustable professional activities for workplace assessment of general practice trainees. Med J Aust. 2019;210:354–359.

 PubMed Web of Science ®Google Scholar

Solymos O, Snyman L, Condon E, et al. Moving beyond the technical skills and promoting professionalism—the experience of the College of Anesthesiologists of Ireland with incorporating the medical council eight domains of good professional practice into entrustable professional activities. Ir J Med Sci. 2020;189:1379–1389.

 Web of Science ®Google Scholar

Holzhausen Y, Maaz A, Roa-Romero Y, et al. What can we expect from medical graduates? Empirical survey on the performance of Core EPAs in the first days of residency. BMC Med Educ. 2020;20:452.

 Web of Science ®Google Scholar

Omoruyi EA, Guardiola A, Barratt MS. Are incoming pediatric interns ready to obtain the essential components of an informed consent for lumbar puncture? Acad Pediatr. 2019;19:410–413.

 Web of Science ®Google Scholar

Emke AR, Park YS, et al. Workplace-based assessments using pediatric critical care entrustable professional activities. J Grad Med Educ. 2019;11:430–438.

 PubMedGoogle Scholar

Schumacher DJ, West DC, Schwartz A, et al. Longitudinal assessment of resident performance using entrustable professional activities. JAMA Network Open. 2020;3:e1919316.

 PubMed Web of Science ®Google Scholar

Djs M, Martini A, Kinnear MB, et al. Facilitators and inhibitors to assessing entrustable professional activities in pediatric residency. Acad Pediatr. Published online: November 20, 2020. DOI:https://doi.org/10.1016/j.acap.2020.11.013

 Google Scholar

CarILee A, Rowat J, Suneja M. Assessing entrustable professional activities using an orientation OSCE: identifying the gaps. J Grad Med Educ. 2019;11:214–220.

 Google Scholar

Dunne D, Green M, Tetrault J, et al. Development of a novel competency-based evaluation system for HIV primary care training: the HIV entrustable professional activities. J Gen Intern Med. 2020;35:331–335.

 Web of Science ®Google Scholar

Kang AJ, Gielissen K, Windish D. Using an entrustable professional activity to assess consultation requests called on an internal medicine teaching service. MedEdPORTAL. 2019;15:10854.

 PubMedGoogle Scholar

Wolcott M, Mason M, Broome A, et al. Faculty perspectives of an entrustable professional activity (EPA) framework in predoctoral dental education. J Dent Educ. 2020;84:955‐ 963.

 Web of Science ®Google Scholar

Baer HR, Gilbert AR, Forster JE, et al. Use of the electrodiagnostic entrustable professional activity for competency assessment in physical medicine and rehabilitation training programs. Am J Phys Med Rehabil. 2020;99:81–85.

 PubMed Web of Science ®Google Scholar

Ju JY, Wehrli G. The effect of entrustable professional activities on pathology resident confidence in blood banking/transfusion medicine. Transfusion. 2020;60:912–917.

 Web of Science ®Google Scholar

Young JQ, Sugarman R, Schwartz J, et al. A mobile app to capture EPA assessment data: utilizing the consolidated framework for implementation research to identify enablers and barriers to engagement. Perspect Med Educ. 2020;9:210–219.

 PubMed Web of Science ®Google Scholar

Pearlman RE, Pawelczak MA, Bird JB, et al. Incoming interns perceived preparedness for core entrustable professional activities. Med Sci Educ. 2019;29:247–253.

 Google Scholar

Stahl CC, Rosser AA, Jung SA, et al. Entrustable professional activities in general surgery: trends in resident self-assessment. J Surg Educ. 2019;229:s244.

 Google Scholar

Stahl CC, Collins E, Jung SA, et al. Implementation of entrustable professional activities into a general surgery residency. J Surg Educ. 2020;77:739–748.

 Web of Science ®Google Scholar

Stahl CC, Jung SA, Rosser AA, et al. Entrustable professional activities in general surgery: trends in resident self-assessment. J Surg Educ. 2020;77:1562–1567.

 Web of Science ®Google Scholar

Brasel KJ, Klingensmith ME, Englander R, et al. Entrustable professional activities in general surgery: development and implementation. J Surg Educ. 2019;76:1174–1186.

 Web of Science ®Google Scholar