Entrustment in Doctor-Patient Communication in Family Medicine Training - a Systematic Review of the Literature

Over recent decades, postgraduate medical education has shifted increasingly towards competency-based frameworks. Entrustable Professional Activities (EPAs) have emerged as a key approach to integrating the assessment of professional practice. While communication is widely recognised as a core competence in Family Medicine, its explicit operationalisation as EPAs remains unclear. This review aimed to map and conceptually analyse how EPAs have been applied to doctor-patient communication in Family Medicine training and to identify communication-intensive clinical activities that can be conceptualised as EPAs. We conducted a systematic review of the literature with qualitative evidence synthesis across five electronic databases (PubMed, Scopus, Web of Science, EBSCO, and SciELO), complemented by citation searching, for studies published in English, Portuguese, Spanish, and French up to October 2025. Eight studies met the inclusion criteria, all using qualitative methodologies, including Delphi studies, expert consensus processes, and focus groups. Communication was most often addressed as a transversal competence embedded within broader EPAs. However, five studies identified 10 discrete communication-focused EPAs, clustered into four domains: breaking bad news, shared decision-making and patient-centred care, dealing with strong emotions, and motivational interviewing or behaviour modification. The findings indicate that, although communication is central to Family Medicine practice, its framing as a set of autonomous, communication-intensive EPAs is still in its early stages of development. Conceptualising high-stakes communication encounters as EPAs may support a more integrative and practice-oriented approach to workplace-based assessment, while highlighting the need for further research on their longitudinal educational impact in postgraduate training.