Importance-based approach to entrustable professional activities for psychiatric residency training

Entrustable professional activities (EPAs) are essential tools in implementing CBME and integrating milestones into clinical practice. This study aimed to develop a set of EPAs tailored to the psychiatric residency training context with local institutional needs, and to dissect the differences and factor analysis in perceived EPA importance.

21 customized EPAs specific to psychiatric residency training at Taipei City Psychiatric Center (TCPC) were developed based on the Taiwanese Society of Psychiatry (TSOP) framework. A two-round Delphi method was used to achieve consensus for the EPAs. The finalized EPAs were evaluated using an online questionnaire, and faculty members and residents rated each activity's importance on a Likert scale of 0-10. Statistical analyses were performed on perceptions differences between teachers and trainees, and to cluster EPAs into meaningful competency clusters.

The finalized TCPC EPA framework included the TSOP's original 17 EPAs and four additional EPAs to address advanced skills in psychotherapy, rehabilitation, legal applications, and innovative technologies. The total response rate was 89.6% for questionnaire assessing importance. Faculty consistently rated EPAs as more important than residents did, particularly clinical documentation, teaching and long-term care planning. Factor analysis revealed two loading factors, referring to internal knowledge and an external communication.

The experience of adapting EPAs from global and national standards to fit the characteristics of a local training institution provides a valuable reference for the localization of EPA development. Observed differences in perceptions between trainees and teachers highlight the importance of aligning educational expectations. Enhancing awareness of the underlying dimensions associated with EPAs may help optimize psychiatric training outcomes for both trainees and instructors.