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Learning from Experience: A Systematic Review of Early Multi-Institutional EPA Studies Across U.S. Medical
Carolyn Cafro1, Lindsay A Tao2, Abel Lindley3
1University of Rochester, School of Medicine and Dentistry, Rochester, New York.
Journal of Surgical Education
|July 23, 2026
Summary
Early multi-institutional studies show Entrustable Professional Activities (EPAs) are feasible in U.S. residency programs but face challenges. Future efforts need better workflow integration and faculty development for successful competency-based assessment.
Area of Science:
- Graduate Medical Education
- Competency-Based Medical Education
- Assessment
Background:
- Entrustable Professional Activities (EPAs) are increasingly adopted in graduate medical education.
- Evaluating EPA implementation across multiple institutions is crucial for understanding real-world application and challenges.
Purpose of the Study:
- To assess the design, implementation strategies, and outcomes of early multi-institutional studies on EPAs in U.S. residency and fellowship programs.
- To inform future EPA implementation by identifying successes and barriers.
Main Methods:
- A systematic literature search of PubMed, Embase, and Scopus was conducted for U.S.-based multi-institutional studies on EPA implementation.
- Studies focused on residency or fellowship training were included; single-institution, undergraduate, and non-U.S. studies were excluded.
- Data extraction and screening were performed independently and in duplicate.
Main Results:
- Five studies published between 2020-2025 in various specialties (e.g., surgery, pediatrics) met inclusion criteria.
- EPA implementation was feasible, with increasing entrustment ratings by trainee level and digital platforms aiding evaluation.
- Key barriers included inconsistent faculty engagement, workflow issues, sampling bias, and redundant systems.
Conclusions:
- Early multi-institutional EPA studies confirm feasibility but highlight persistent implementation challenges.
- Future EPA initiatives should focus on seamless workflow integration, robust digital assessment tools, and comprehensive faculty development.
- Sustainable competency-based assessment requires addressing these identified barriers.
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