When using entrustable professional activities thwarts basic psychological needs: A case study of residents'...

Area of Science:

• Medical Education Research
• Competency-Based Medical Education
• Psychology in Medicine

Background:

• Entrustable professional activities (EPAs) aim to connect competencies with clinical practice for resident development.
• Concerns exist regarding burdensome documentation and limited educational value of EPAs.
• Self-Determination Theory (SDT) provides a framework to understand resident motivation and professional growth.

Purpose of the Study:

• To explore residents' experiences with EPAs.
• To examine how EPAs relate to residents' needs for autonomy, competence, and relatedness.
• To identify factors influencing the effectiveness of EPAs in resident professional development.

Main Methods:

• An instrumental case study design was employed in a Canadian internal medicine residency program.
• Fourteen residents participated in semi-structured interviews.
• Thematic analysis guided by Self-Determination Theory (SDT) was used to interpret resident narratives.

Main Results:

• Residents perceived EPAs as compliance exercises detached from meaningful development.
• Four themes emerged: "A Documentation Imperative" (constraining autonomy, undermining competence), "Fleeting Convergences" (separate trajectories of EPAs and competence), "Electronic Barriers" (weakening relatedness, reducing autonomous engagement), and "A Binding Burden" (relatedness focused on coping).
• External pressures and transactional processes hindered residents' basic psychological needs.

Conclusions:

• Current EPA implementation often fails to foster conditions for meaningful engagement.
• Documentation burdens, weak competence support, and strained relatedness impede EPA effectiveness.
• Revisions are necessary for EPAs to function as intended units of professional practice for residents.