Entrustable professional activities in medical education: strategies and results - a systematic review

Medical education has been marked in the last decades by the introduction of Competence-Based Medical Education (CBME). Despite its clear objectives, CBME has faced significant challenges and Entrustable Professional Activities (EPAs) have been conceptualised as an answer to some of those challenges.

This systematic review aimed primarily to summarise the evidence published on the strategies used for the development, implementation, and assessment of EPAs and their results. Secondarily this review also aimed to characterise the body of evidence produced on EPAs, assess its quality, and explore its limitations and future research paths.

Systematic searches were conducted in six electronic databases in July 2021 and updated in March 2025. The data extracted included the quality assessment of the studies considered using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).

Four hundred and seventy-eight studies were included for data extraction and posterior analysis, most of which referred to Postgraduate programmes (59.6%, n = 285) and took place in the USA (51.5%, n = 246). A relevant diversity of methodologies and stakeholders involved was detected in the development, implementation, and assessment of EPAs. References to factors influencing the implementation of EPAs (50.8%, n = 243) and the potential of implementing EPAs for the improvement of learning and assessment practices (46.4%, n = 222) were found in a significant number of studies, but only a small number focused on the cost-effectiveness of the use of EPAs. The quality analysis of the included studies revealed modest results.

This broad systematic review highlights the increasing adoption of EPAs, showcasing the diversity of contexts and strategies for the development, implementation, and assessment of EPAs. Nevertheless, significant challenges persist, namely concerning study quality, warranting further research.