Entrustable Professional Activities in Residency Training: A Qualitative Study on Trainees' Perceptions Using the Consolidated Framework for Implementation Research
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Fabienne Schwitz1,2, Vera Bissig3,2, Monika Brodmann Maeder2,4
1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Introduction:
Entrustable Professional Activities (EPAs) represent an integral component of Competency-Based Medical Education (CBME). They provide a practical framework to assess a trainee's readiness to perform clinical tasks with increasing independence. This study investigates trainees' perceptions of EPAs, including benefits, obstacles, shifts in feedback culture, and changes in assumed responsibility using the Consolidated Framework for Implementation Research (CFIR) as a theoretical framework.
Methods:
We conducted a theory-informed qualitative study using semi-structured interviews with cardiology trainees in Switzerland to examine early implementation of Entrustable Professional Activities (EPAs). The study was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed using the Framework Method, drawing on CFIR to inform the deductive analysis while identifying context-specific aspects of participants' experiences inductively.
Results:
We identified ten themes, of which the most prominent were 'Impact of time constraints for EPA assessment', 'Incorporating EPAs into workflows', 'Satisfaction with EPA App', and 'Enhancement of Feedback through EPAs'. Trainees perceived the use of EPAs as increasing feedback opportunities but reported that their educational value depended largely on time availability, workflow integration, and supervisor engagement.
Discussion:
Our findings suggest that the implementation and educational value of EPAs depend not only on the introduction of EPA-based assessments themselves but also on the interaction between structural conditions and social factors. Based on these findings, we formulated seven recommendations for training sites implementing EPAs. These are: Carry out assessments carefully, assess EPAs at handover, allocate time for assessments, begin assessments early in postgraduate medical education, provide all affected parties with thorough training, improve didactic competencies and share responsibility of assessments.