An In-Depth Exploration of the Entrustable Professional Activity Assessment Related Experiences, Perceptions and...

The transition to Competence by Design (CBD) and the introduction of Entrustable Professional Activity (EPA) assessments have elicited mixed emotions among residents and faculty, which is important as negative emotions have been shown to hinder learning. Hence, this study explores the experiences, perceptions and associated emotions of residents and faculty regarding EPA assessment processes, including when and how experiences are linked with emotions.

This qualitative descriptive study employed semistructured interviews with residents and faculty from Pediatrics, General Surgery and Emergency Medicine programs at a university (2023-24). Inductive reflexive thematic analysis was conducted to analyse the data.

Participants included 10 residents and 13 faculty. Seven themes were identified: (1) Residents and faculty describe changing emotions regarding EPA assessment experiences across implementation stages; (2) Residents and faculty feel uncertain about the educational relevance of EPAs, while procedural EPAs and assessments are perceived as more meaningful for learning; (3) Faculty and residents describe frustration when EPA assessment platforms disrupt workflow and assessment engagement; (4) Confusion and frustration arise when numerical scores do not align with feedback in EPA assessments; (5) Emotions regarding simulation-based EPA assessments depend on perceived authenticity and opportunities for learning; (6) Residents and faculty feel overwhelmed and fatigued when high assessment volume is perceived as misaligned with learning and realities of the clinical setting; (7) Sharing EPA assessment experiences with leadership and colleagues: Not as common as one might think.

Residents and faculty have mixed perceptions and emotions associated with EPA assessment processes, influenced by specialty-specific implementation and logistical challenges. Our findings may support residency programs in recognizing instances of negative emotions, and optimizing EPA assessment processes to support learning.