A Systematic Review Evaluating the Implementation of Entrustable Professional Activities in Family Medicine Programs

Entrustable Professional Activities (EPAs) aim to align medical education with real-world clinical practice through a task-based, competency-oriented approach. Despite increasing global interest, the implementation of EPA in postgraduate Family Medicine remains inconsistent. This systematic review examines international experiences with EPAs in Family Medicine, focusing on reported benefits, challenges, and lessons for curriculum development.

A systematic review of studies published between 2004 and 2024 was conducted. Data were appraised using the Mixed Methods Appraisal Tool (MMAT) version 2018, with thematic synthesis guided by a program logic model. Systematic reviews, book chapters, and letters to the editor were excluded. Searches were conducted in Scopus, PubMed, EBSCOhost, BMJ, JSTOR, ScienceDirect, and Google Scholar.

Eleven studies met the inclusion criteria. Four themes emerged: clarification of EPA terminology and conceptual foundations, implementation stages and strategies, differences between the Global North and the Global South, and educational benefits and barriers. Methodological quality was high, with MMAT scores ranging from 71% to 100%. Studies emphasized the contextually relevant design of EPA and the use of multiple workplace-based assessment data points to support entrustment decisions across diverse clinical settings. Reported benefits included clearer performance expectations, improved assessment transparency, and enhanced formative feedback. Key challenges included integrating into existing curricula and assessment systems, addressing faculty development needs, and overcoming institutional resistance.

Despite challenges, EPAs demonstrate strong potential to advance competency-based postgraduate training and enhance quality assurance in Family Medicine, providing practical guidance for curriculum reform and workplace-based assessment.