Consensus development of entrustable professional activities for gastroenterology fellowship training in Saudi Arabia: a modified Delphi study

Entrustable professional activities (EPAs) translate competency frameworks into observable units of professional work and provide a practical basis for supervision, feedback, and progressive responsibility. International gastroenterology curricula and EPA frameworks offer valuable reference models, but their terminology, sequencing, and assessment assumptions reflect the systems in which they were developed. A nationally contextualized framework may therefore help align the Saudi Fellowship Adult Gastroenterology Program with workplace-based competency assessment.

A two-round modified Delphi study was conducted with geographically diverse consultant gastroenterologists and educators involved in fellowship training and trainee assessment in Saudi Arabia. Preliminary EPAs were derived from review of gastroenterology competency and EPA frameworks, alignment with the national fellowship curriculum, expert review, and pilot refinement of an electronic questionnaire. Panelists judged the relevance and representativeness of candidate activities and provided iterative feedback. Item-level consensus was examined across rounds, and Cronbach's alpha was used to describe the internal consistency of panel ratings.

Participation was appropriate for the study purpose and remained strong across the two rounds. Consensus increased after controlled feedback and revision. The reported Cronbach's alpha exceeded 0.90, indicating high internal consistency among panel ratings. Review of item granularity showed that several discrete clinical-assessment behaviors were better represented as key features within broader patient-management activities than as standalone EPAs.

The study provides expert-consensus evidence supporting the content relevance and representativeness of a Saudi gastroenterology EPA framework for curriculum development. It does not establish that the framework is valid for high-stakes entrustment decisions, feasible in all clinical settings, or associated with improved educational or patient outcomes. Prospective multicenter implementation, faculty development, stakeholder engagement, and a purpose-specific validity argument are required before national assessment use.