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Medical Students' Acceptance of Digital Entrustable Professional Activities: Results of a Cohort Study
Maximilian Domann1, Constanze Richters1, Matthias J Witti1
1Institute of Medical Education, LMU University Hospital, LMU Munich, Pettenkoferstr. 8A, Munich, Bavaria, 80336, Germany, 49 089 4400 ext 57360.
Background:
Digital entrustable professional activities (EPAs) in simulated environments may accelerate competency acquisition, but adoption depends on learner acceptance. The Technology Acceptance Model (TAM) posits that perceived usefulness (PU) and perceived ease of use (PEU) shape attitudes (AT) and, in turn, behavioral intention (BI).
Objective:
This study aimed to examine medical students' acceptance of digital EPAs and to test the hypothesized TAM relationships among PU, PEU, AT, and BI.
Methods:
Clinical-phase medical students at Ludwig Maximilian University of Munich completed a TAM-based survey (7-point Likert scales) after reading a canonical analog EPA and its digital counterpart. Confirmatory analyses comprised bivariate correlations and hierarchical regressions testing TAM paths. Exploratory analyses comprised paired-sample two-tailed t tests comparing analog versus digital ratings and path modeling to evaluate global TAM fit.
Results:
Between 70 and 72 medical students provided complete, usable responses, depending on the construct. Mean ratings were favorable (≈5/7). Internal consistency was acceptable (ω=.67-.80). Within the digital EPAs, PU strongly predicted AT (β=.59; P<.001), and AT predicted BI (β=.58; P<.001). For the analog EPAs, PU (β=.54; P<.001) and PEU (β=.28; P=.005) predicted AT; both AT (β=.42; P<.001) and PU (β=.36; P=.002) predicted BI. Attitudes were modestly higher for analog versus digital (M=5.18 vs 4.87; t71=-2.50, d=-0.30; P=.02), but PU, PEU, and BI did not differ significantly. The path models indicated excellent fit for both formats (comparative fit index=1; root mean square error of approximation=0; standardized root mean square residual ≤.01).
Conclusions:
Students reported high acceptance of digital EPAs. Acceptance was driven primarily by PU (via AT), whereas PEU contributed to AT only for analog EPAs. Implementation should emphasize demonstrable educational value and cultivate positive attitudes; subsequent work should link acceptance to actual use and learning outcomes.
