Assessing Core Entrustable Professional Activities in the pre-clerkship Phase of Undergraduate Medical Education

To describe the implementation of selected core Entrustable Professional Activities (EPAs) for entering residency in the pre-clerkship program of undergraduate medical education and analyze the growth curves of these EPAs over 12 months.

A total of 242 (128 women-53.0%; 114 men-47.0%) first and second year University of Minnesota Medical School students, with mean age = 24.6 (SD = 2.81) at matriculation, participated. Students enrolled in a required Early Clinical Experience course requested EPA assessments by supervisors (residents, faculty members) while working on a patient case together. Assessments were depicted as curves describing student performance over the course of their ECE from November 2023 to November 2024. Regression models were employed to fit the curves, and reliability was examined with a generalizability analysis (Ep2 coefficients).

There were 6,689 EPA-based assessments with a mean number of 28 (SD = 8.2) assessments per student, provided by 786 assessors (residents and faculty members). Growth curves of the EPA ratings follow predicted negative exponential learning theory with baseline performance, a latent phase, subsequent rapid growth and eventual rate of learning deceleration. The slope of the growth curves demonstrates considerable variation by EPA. For a subset of the EPAs assessed on at least 8 occasions, adequate reliability (Ep2 coefficient >0.7) was achieved with 4 raters assessing on 4 occasions.

The results of this analysis are consistent with learning theory and suggest EPA ratings provide reliable and valid data about acquisition of clinical skills for learners in the pre-clerkship phase of training. These results provide further evidence for the value of early clinical experiences and demonstrate EPA assessments can be a meaningful method of assessment for these early learners. This early EPA program has promise as a standardized learning and assessment system during pre-clerkship experience in medical education to guide curriculum and teaching improvement.