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Functional Near-Infrared Spectroscopy Hyperscanning Study in Psychological Counseling
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When using entrustable professional activities thwarts basic psychological needs: A case study of residents'

Julien-Carl Phaneuf1,2, Carolin Sehlbach1,3, Annaëlle Gauvin-Morin4

  • 1School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Medical Teacher
|May 23, 2026
PubMed
Summary

Entrustable professional activities (EPAs) often burden residents with documentation, hindering professional development and undermining autonomy and competence. Current EPA use requires significant changes to support meaningful engagement and resident growth.

Keywords:
Assessmentcompetency-based educationinternal medicinepostgraduate medical education

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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.