Examining enablers and barriers to entrustable professional activity acquisition using the theoretical domains...

Area of Science:

• Medical Education Research
• Competency-Based Medical Education (CBME)
• Professionalism in Medicine

Background:

• Effective acquisition of high-quality entrustable professional activity (EPA) assessments is vital for medical training programs.
• Lack of understanding regarding EPA assessment factors hinders successful implementation and utilization by trainees, faculty, and programs.
• Barriers and facilitators to high-quality EPA assessments in Canadian emergency medicine (EM) training programs require identification.

Purpose of the Study:

• To identify barriers and facilitators to acquiring high-quality EPA assessments in Canadian EM training programs.
• To inform strategies for successful EPA implementation and utilization in medical education.

Main Methods:

• Qualitative framework analysis utilizing the Theoretical Domains Framework (TDF).
• Semistructured interviews were conducted with EM residents and faculty.
• Interviews were audio-recorded, deidentified, and coded line-by-line to extract themes across TDF domains.

Main Results:

• Identified major themes and subthemes for barriers and facilitators to EPA acquisition across 14 TDF domains.
• The most cited domains were environmental context and resources (56) and behavioral regulation (48).
• Strategies include resident orientation to CBME, faculty development, and longitudinal coaching for feedback.

Conclusions:

• Key strategies were identified to support residents, faculty, programs, and institutions in improving EPA assessment processes.
• Addressing barriers and facilitators is essential for successful CBME implementation and EPA operationalization in EM training.
• This study provides a foundation for enhancing EPA assessment quality and effectiveness in medical education.