Development and preliminary validation of an entrustable professional activities framework for undergraduate...

This study aimed to develop and preliminary validate an entrustable professional activities (EPAs) framework for undergraduate midwifery students in China, providing a reference for undergraduate midwifery education and competency assessment.

An initial EPA framework was constructed through a systematic literature review, qualitative research, and participant observation. From January to March 2022, semi-structured interviews were conducted with 27 stakeholders, followed by participant observation involving six individuals from April to May 2022. Subsequently, two rounds of Delphi consultation were conducted from June to October 2022 with 24 experts from 11 tertiary hospitals and six universities offering midwifery programs across eight provinces in China. Experts evaluated the importance, appropriateness, and entrustment level settings of each item, and the framework was revised accordingly. The finalized framework was then converted into a questionnaire and administered to undergraduate midwifery interns from three universities in Fujian Province to conduct a preliminary validation of its application.

Response rates for the two Delphi rounds were 87.5 % and 83.3 %, respectively. Kendall's coefficients of concordance were 0.126 and 0.147 (P < 0.001), and expert authority coefficients (Cr) were 0.864 and 0.873. The finalized framework comprised three confidence levels, 11 core EPAs, and 60 nested EPAs. In the preliminary validation phase, 81 valid questionnaires were collected. The overall Cronbach's α coefficient was 0.967, and the test-retest reliability (ICC) was 0.675, indicating good internal consistency and stability.

The developed EPAs framework for undergraduate midwifery students demonstrates sound scientific rigor and feasibility and may provide theoretical and practical guidance for reforming undergraduate midwifery education and evaluating competency in China.