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

Karsten Arthur Van Loon,Fedde Scheele,Nynke Van Dijk,Linda Helena Anna Bonnie

doi:10.1007/s40037-021-00658-9

Abstract

IntroductionEntrustable 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.MethodFor 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.ResultsAn 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.DiscussionDue 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.Supplementary InformationThe online version of this article (10.1007/s40037-021-00658-9) contains supplementary material, which is available to authorized users.

Highlights

Introduction Entrustable ProfessionalActivities (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
Based on the research results of this study, we aimed to evaluate the extent to which the benefits of working with Entrustable Professional Activities (EPAs) are at risk when the uptake of EPAs in national training plans is influenced by the workplace environment
Interviewees stated that the number of EPAs in the curriculum depended on the training context of the PGME programmes

Summary

Introduction

Introduction Entrustable ProfessionalActivities (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. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. Across the world, programmes for postgraduate medical education (PGME) use competence frameworks, such as the Canadian Medical Education Directives for Specialists (CanMEDS) or the framework of the Accreditation Council for Graduate Medical Education (ACGME), as the foundation of their training. Programmes for postgraduate medical education (PGME) use competence frameworks, such as the Canadian Medical Education Directives for Specialists (CanMEDS) or the framework of the Accreditation Council for Graduate Medical Education (ACGME), as the foundation of their training These frameworks describe the competences that health-care professionals should acquire during their training [1] and are used for assessment and for structuring the trainee learning process [2]. The overall aim of the competence frameworks, which was to ensure a comprehensive approach to medical education, is under threat [4, 5]

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