Entrustable professional activities (EPAs) for undergraduate medical education – development and exploration of social validity

Christina Gummesson, Stina Alm, Anna Cederborg, Mattias Ekstedt, Jarl Hellman, Hans Hjelmqvist, Magnus Hultin, Katarina Jood, Charlotte Leanderson, Bertil Lindahl, Riitta Möller, Björn Rosengren, Anders Själander, Peter J. Svensson, Stefan Särnblad, Alexander Tejera

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review


Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders. Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs. Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed. Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’. Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

TidskriftBMC Medical Education
StatusPublished - 2023 dec.

Bibliografisk information

Funding Information:
We want to thank Marie Dahlin Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, Lotta Fornander, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden and Department of Orthopedic Surgery, Norrköping, Sweden, and Anna Freyschuss, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden for valuable engagement and important contribution in finalizing the Core EPAs. (Permission from the persons named has been granted.)

Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.

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