How Do Trainees Use EPAs to Regulate Their Learning in the Clinical Environment? A Grounded Theory Study

Area of Science:

• Medical Education
• Professional Development
• Self-Regulated Learning

Background:

• Entrustable Professional Activities (EPAs) are proposed to enhance clinical learning.
• Concerns exist regarding potential negative impacts, such as 'checkbox behavior'.
• The interplay between EPAs and self-regulated learning (SRL) in clinical settings requires further investigation.

Purpose of the Study:

• To explore how general practice (GP) trainees utilize EPAs within their clinical environment.
• To understand whether EPAs facilitate or impede trainee learning through the framework of SRL theory.

Main Methods:

• Constructivist grounded theory methodology was employed.
• A purposive and theoretical sample of GP trainees participated in interviews.
• Constant comparative analysis guided data collection and analysis.

Main Results:

• Trainees' use of EPAs evolved through three stages: adaptation, taking control, and "checking the boxes."
• EPAs were most beneficial during the "taking control" phase.
• EPAs hindered SRL in later stages due to perceived bureaucracy and misaligned learning goals, though supervisor discussions proved beneficial.

Conclusions:

• EPAs present a dual potential to both aid and obstruct SRL in clinical training.
• The effectiveness of EPAs is dynamic and changes as trainees progress.
• Supervisors play a crucial role in helping trainees navigate and optimize the use of EPAs for learning.