Integrating Entrustable Professional Activities in Simulation-Based Health Care Education: A Systematic Literature...

Entrustable professional activities (EPAs) transform abstract clinical competencies into practical measurable tasks. Integrating simulation and EPAs may support continuous improvement in health professions training by linking competency development and observable clinical tasks in a standardized environment. This study analyses the usability of EPAs in simulation-based education. The review search was conducted in 6 databases up to May 27, 2025. Twenty-two studies, including 3144 health care trainees, were included. EPA-integrated simulations improved learners' confidence across different stages of health care training. EPA-based evaluations in simulation also yield moderately to highly reliable scores and show emerging validity with positive correlation with other competence measures. Important practical barriers include high resource requirements, rater calibration, and assessment challenges. EPAs in simulation-based health care education, especially up to the graduate level, may be valid tools to support learning and feedback. Preliminary evidence suggests potential utility for competency-based progression, but further research is needed to define a resource-sensitive implementation.