To provide an overview of the current use of Entrustable Professional Activities (EPAs) in postgraduate general surgery training internationally.

Entrustable Professional Activities (EPAs) were introduced to connect clinical competencies and the professional activities to be entrusted to trainees on graduation. The popularity of EPAs as a framework for assessment is growing globally, including in general surgery. Anecdotally, there appears to be substantial variation in how they are implemented, yet a formal comparison of their use in postgraduate general surgery training is lacking.

A scoping review was performed based on the original 5-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR).

Twenty-nine published and grey literature sources were included in the review. Entrustable Professional Activity use in postgraduate general surgery training was identified in 11 unique contexts, including from North America, South America, Europe, Asia, Africa, and Australia. There were substantial differences in the scope and number of EPAs, tools used for EPA assessment, and how EPAs were sequenced through training. Despite the wide variation, 8 distinct EPAs were common to the majority (>80%) of countries. Several articles described findings of EPA use in postgraduate general surgery training, allowing the identification of multiple barriers and facilitators to integration.

This review provides guidance for certification and regulatory bodies, program directors, and institutions with ambitions to implement EPAs for assessment and curricular design. In settings where EPAs are already used, the data may facilitate the refinement of programs and strategies.

Training programs focused on dysphagia have been identified as an area needing improvement due to the specialized skills required to provide clinical care to patients with dysphagia. Globally, a lack of standardized training has been recognized and has led to the introduction of competency and training frameworks in the clinical practice of dysphagia. Previous studies have explored the experiences of students in training programs and their self-perceived competency; however, none have explored this in the Ethiopian context due to the infancy of the Speech Language Therapy (SLT) profession within this region. The objectives of this study were to explore patterns in self-perceived competency ratings for SLT students at AAU and determine the impact of clinical experiences during student training.

First- and second-year students enrolled in the two-year SLT Master's program in Ethiopia were taught the dysphagia course in a combined class in English by visiting faculty. A modified Dysphagia Competency Verification Tool (DCVT) was used to assess self-perception of competency in dysphagia. The tool was administered in April 2024, before any dysphagia-related clinical exposure occurred and once again in May 2024, after clinical exposure to patients with dysphagia occurred. Generalized estimating equations (GEE) models were used for the General Skills (DCVT-GS) and Direct Patient Care (DCVT-DPC) subtests to study variations in responses for self-perceived competency. The models included covariates of sex, background in SLT, dysphagia-specific patient exposure and a repeated factor of survey timepoint.

In total, 38 responses were collected across two time points and from all 19 participants. The SLT students were mostly female (n = 16; 84%) with ages ranging from 21 to 46 years. The GEE model for DCVT-GS identified significant main effects of background in SLT (p = 0.018), dysphagia patient exposure (p = 0.019), and survey timepoint (p < 0.001). The GEE model for DCVT-DPC demonstrated significance for background in SLT (p < 0.001), dysphagia patient exposure (p = 0.009), and sex (p = 0.031).

Regardless of DCVT domain, SLT graduate student clinicians were more likely to perceive themselves as "adequate" in their ratings at the second timepoint following clinical interactions, if they had prior SLT experience, including prior dysphagia experience. Training programs exploring dysphagia competency are encouraged to provide increased exposure to patients with dysphagia to support increased self-perceived competency scores.

The Royal Australasian College of Surgeons' Board in General Surgery implemented Entrustable Professional Activities (EPAs) in its competency-based training programme in 2022. As this is a new method for surgical trainees, a qualitative study was performed to evaluate its implementation and use by exploring the pioneer trainees' perceptions and experiences of EPAs.

Seven first-year general surgery trainees were recruited to participate in semi-structured interviews. The interviews explored the trainees' experiences of EPAs, their perceptions of the effect on their independence with completing clinical activities and patient safety, and their suggestions for how to improve this form of assessment in the training program.

The findings of the study suggest that EPAs can be a useful tool for assessing the competence of trainees. However, the study also found that EPAs can be challenging for trainees, particularly in terms of the level of self-regulation and independence required.

Although EPAs may positively contribute to a trainee's experience, considerations to support trainees and trainers in their practical implementation may increase the value of the learning encounter. Graded assessment of entrustment and explicit year-level milestone progress points could promote more effective learning and support developmental feedback by trainers.

Outcome-based medical education is the latest focus in the past decade, and Entrustable Professional Activities(EPAs) have emerged as efficient vehicles to assess physicians. However, few studies have discussed the use of EPAs for residency training in pediatric medicine and its subspecialties. We conducted a pilot study to examine the feasibility of EPAs as a component of the clinical program of assessment in pediatric standardized residency training.

We conducted a cross-sectional study for standardized residency training in different subspecialties within pediatric medicine at Qilu Hospital of Shandong University. Totally 65 residents and 35 directors joined in this study. An electronic EPA survey using 8 scales composed of 15 categories was distributed among residents and directors. Kruskal-Wallis test and Mann-Whitney U test were applied for comparing the self-assessments and director-assessments. Generalized estimated equation (GEE) was used to analyze the effect of postgraduate year(PGY), gender, and position on the EPA scores of director assessments.

A total of 401 director-assessment and 65 residents' self-assessment ( response rate 100%) questionnaires were collected, both demonstrating rising trends in scores across PGYs. Significant differences were found between PGY1 and PGY2 (p < 0.01) and between PGY1 and PGY3 (p < 0.01), but not between PGY2 and PGY3 (p > 0.01). With an effect analysis of PGY, gender, and position on EPA scores performed, PGY had a significant effect on 13 out of 15 EPA scores, while gender affected only four EPA scores significantly, and position affected only three EPA categories. Meanwhile, some EPA categories revealed significant differences across various pediatric subspecialties (p < 0.01).

The study findings suggest that EPA assessments is feasible among different PGYs in standardized Chinese residency training in pediatric medicine and its subspecialties. Postgraduate year had a significant impact on EPA scores, while gender and resident position also affected EPA scores to a certain extent. Improved stratified teaching programs are required for better subspecialty consistency.

Entrustable Professional Activity (EPA)-based residency programmes are designed to offer structure, flexibility, and a gradual increase in autonomy. While residents are expected to take an active role in their learning, little is known about how they actually experience learning and working within the EPA framework. This study explores paediatric residents' experiences of learning, working, and developing within an EPA-based training programme.

We conducted a qualitative study using semi-structured interviews with 11 paediatric residents from three of the seven Dutch training regions. Interviews were transcribed verbatim, anonymised, and analysed using template analysis to identify themes related to residents' learning and professional development within EPA-based training.

Residents described increasing confidence and competence in the phase prior to entrustment. Some linked this development to the EPA structure, as it supported goal setting and feedback-seeking, while others attributed this development primarily to learning through clinical experience.The entrustment decision process-particularly the Clinical Competence Committee (CCC) feedback-was seen as reassuring, though residents also described discomfort with being evaluated by a group. After entrustment, residents experienced greater autonomy but noted variation in supervision practices. Some felt unsure about when to request supervision, particularly in apparently straightforward settings. Others described feeling empowered to pursue individualised learning opportunities.

In reflecting on these findings, we drew on the concept of Self-Regulated Learning to explore how residents engaged with their training. Making these principles more explicit within EPA-based programmes may support residents in optimising their learning and strengthen their preparation for independent practice.

In medical education, entrusted professional activities (EPAs) have been an integral part of the curriculum, primarily being used in clinical traineeships and postgraduate medical education. The use of EPAs in postgraduate medical education is transferable to dental training, as clinical skills are already part of the curriculum. The data from this study could help propose dental EPAs that reflect competencies expected in the professional field, potentially aiding in more effectively evaluating student competencies and standardizing assessment criteria.

After research on the use of EPAs in dental education across Europe, Asia, and the United States, 21 EPAs were chosen, covering all areas currently taught in the German dental graduate program, and matched with the domains of the National Catalog of Learning Objectives in Dentistry. Following, an electronic survey was developed and distributed to dentists working at university hospitals in the Rhine-Main region, as well as in private practices. Participants were asked to evaluate each EPA statement on a 6-point Likert scale and encouraged to provide qualitative feedback on the EPAs.

120 participants responded to the survey (20.7%). Overall, there was substantial agreement on the EPAs chosen to represent the tasks expected of young dentists on their first day in practice. Participants also provided qualitative feedback in the form of optional comments. Concerns raised included the perceived lack of experience for certain tasks.

The data from this study suggest that the proposed EPAs accurately reflect the professional tasks expected of newly graduated dentists on their first day in practice.

This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).

At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.

Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).

While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.

This study examines the feasibility and psychometric results of an assessment of entrustable professional activities (EPAs) as a core component of the clinical program of assessment in undergraduate medical education, assesses the learning curves for each EPA, explores the time to entrustment, and investigates the dependability of the EPA data based on generalizability theory (G theory) analysis.

Third-year medical students from the University of Minnesota Medical School in 7 required clerkships from May 2022 through April 2023 were assessed. Students were required to obtain at least 4 EPA assessments per week on average from clinical faculty, residents supervising the students, or assessment and coaching experts. Student ratings were depicted as curves describing their performance over time; regression models were used to fit the curves.

The complete class of 240 (138 women [58.0%] and 102 men [42.0%]) third-year medical students at the University of Minnesota Medical School (mean [SD] age at matriculation, 24.2 [2.7] years) participated. There were 32,614 EPA-based assessments (mean [SD], 136 [29.6] assessments per student). Reliability analysis using G theory found that an overall score dependability of 0.75 (range, 0-1) was achieved with 4 assessors on 4 occasions. The desired level of entrustment by academic year end was met by all 240 students (100%) for EPAs 1, 6, and 7, 237 (98.8%), 236 (98.3%), and 218 (90.8%) students for EPAs 2, 5, and 9, respectively, 197 students (82.1%) for EPA 3, 178 students (74.2%) for EPA 4, and 145 students (60.4%) for EPA 12. The most rapid growth was for EPA 2 (β 0 = .286), followed by EPA 1 (β 0 = .240), EPA 4 (β 0 = .236), and EPA 10 (β 0 = .230).

The study findings suggest that EPA ratings provide reliable and dependable data to make entrustment decisions about students' performance.

Entrustable professional activities (EPAs) are set to assess residents' capacity to perform professional units close to the context of their future clinical practice. The aim was to define a concise list of EPAs covering the broad specialty of Physical and Rehabilitation Medicine (PRM) to implement a systematic and consistent assessment of trainees' competencies during their residency. A list of EPAs was developed based on a literature review and working group. This list was then submitted to academic PRM professors for validation via a Delphi process. Two rounds were planned with intermediate and final discussion meetings by an external steering committee. Ten EPAs were developed in a first draft. Each of the seven parts of the EPAs obtained validation through the Delphi process. A list of 11 clinical contexts of application was approved to integrate the EPAs in the different areas of PRM. The next step will be the deployment of these EPAs for the validation of residency internships.

Doctors' interactional competencies play a crucial role in patient satisfaction, well-being, and compliance. Accordingly, it is in medical schools' interest to select candidates with strong interactional abilities. While Multiple Mini Interviews (MMIs) provide a useful context to assess such abilities, the evaluation of candidate performance during MMIs is not always based on a solid theoretical framework. The newly developed selection procedure "Interactional Competencies - Medical Doctors (IC-MD)" uses an MMI circuit with five simulation patient scenarios and is rated based on the theoretically and empirically grounded construct of emotional availability. A first validation study with N = 70 first-semester medical students took place in 2021. In terms of convergent validity, IC-MD ratings showed strong correlations with simulation patients' satisfaction with the encounter (r =.57) but no association with emotional intelligence measures. IC-MD ratings were not related to high school performance or a cognitive student aptitude test, indicating divergent validity. Inter-rater reliability (ICC = 0.63) and generalizability (Eρ2 = 0.64) were satisfactory. The IC-MD proved to be fair regarding participants' age and gender. Participants with prior work experience in healthcare outperformed those without such experience. Participant acceptance of the procedure were good. The IC-MD is a promising selection procedure capable of assessing interactional competencies relevant to the medical setting. Measures of interactional competencies can complement the use of cognitive selection criteria in medical student admission. The predictive validity of the IC-MD needs to be addressed in future studies.

To present workplace-based entrustable professional activities (EPAs) assessment data from the first 2 years of the EMYWAY platform in otolaryngology residency training in Taiwan.

Two-year cross-sectional study.

Otolaryngology training programs.

In 2020, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery (TSO-HNS) developed a workplace-based assessment (WBA) framework with 11 EPAs, integrating milestones to evaluate resident competency. In 2021, TSO-HNS piloted the EMYWAY platform for WBAs, which includes an EPA-based assessment workflow, coaching feedback, and a dashboard displaying residents' entrustment-supervision levels. Data are analyzed annually for accreditation and curriculum enhancement. This study reports on the pilot year and the first full-scale year of implementation.

Eleven programs participated in the pilot year. Subsequently, 362 faculty members and 274 resident physicians from 34 programs nationwide engaged with EMYWAY. In the full-scale year from August 2022 to July 2023, 9805 responses were recorded, primarily from surgical theaters (45.9%; 4502/9805) and third-year residents (23.8%; 2331/9805). The most frequently evaluated EPAs were "head and neck" (17.5%; 1716/9805), "sinonasal" (13.5%; 1324/9805), and "ear" (12.2%; 1193/9805), with task complexity increasing with resident seniority (P < .0001). A positive correlation was found between residents' self-assessments and faculty members' ratings (r = 0.531; P < .001). Over 98.2% of residents and 88.4% of faculty members provided substantial feedback (>10 words). Analysis of WBAs reported by training programs identified faculty development targets and teaching-intensive tasks.

EMYWAY effectively documents workplace learning and tracks resident competency progression. Continuous improvement of WBA quality is essential for advancing the competency-based medical education ecosystem.

Entrustable professional activities (EPAs) are increasingly being adopted as an assessment tool by medicine and other health professions in a bid to enhance competency-based health professional education. EPAs are well-defined professional activities that can be entrusted to students to perform with varying levels of supervision. They were introduced to overcome some of the limitations of traditional assessment methods of competency such as individual skills assessment or Direct Observation of Procedures and Objective Structured Clinical Examinations. Could EPAs be beneficial in Australian and New Zealand optometric clinical education for advanced skills training and accreditation including the credentialing assessment of overseas educated practitioners? This paper discusses the historical context of how competencies were introduced and assessed in Australian optometry, the evolution of the concept of EPAs in medicine and other health professions, their design and implementation worldwide and whether EPAs could be adopted into optometric training and assessment in Australia and New Zealand.

This study aimed to identify and synthesise the evidence on factors influencing the incorporation of Entrustable Professional Activities into assessment in nutrition and dietetics education.

A systematic review was conducted with a narrative synthesis and was undertaken and reported in accordance with the PRISMA guidelines. Six electronic databases were searched (MEDLINE, CINAHL, SCOPUS, PsycINFO, Web of Science, and EMBASE) on 9 September 2024. Methodological quality was assessed using the Critical Appraisal Skills Program checklists. Key patterns identified from the narrative synthesis of the included manuscripts were labelled as themes and represented in a figure.

Across the international literature, six articles were identified revealing six main and interconnected themes related to factors influencing the incorporation of Entrustable Professional Activities in nutrition and dietetics. In summary, development and review processes for Entrustable Professional Activities require key stakeholder engagement in addition to ensuring they are linked to assessment structures and existing frameworks. Furthermore, technology platforms and applications appeared to support Entrustable Professional Activity incorporation, and training is an important part of integration.

Further research on factors influencing incorporation is occurring and is suggested to continue, especially given Entrustable Professional Activities seemingly offer a tangible option to simplify the intricacy of competency-based assessment in work-based practice. However, further research to enhance understanding of whether Entrustable Professional Activities support nutrition and dietetics learners and assessors in undertaking high-quality assessment with utility is warranted.

Making entrustment decisions (granting more responsibility, advancement and graduation) are important actions in medical training that pose risks to trainees and patients if not done well. A previous realist synthesis of the existing literature revealed that clinical competency committees (CCCs) do not typically make deliberate entrustment decisions, instead defaulting to the promotion and graduation of trainees in the absence of red flags. This study sought further understanding of these areas through empirical data.

The authors conducted a realist inquiry to better understand how CCC prospective entrustment decision-making is carried out in paediatric residency programs. They conducted four CCC meeting observations and 18 interviews with CCC members at eight sites in an effort to confirm, disconfirm, and elaborate an existing theory that was based on a literature synthesis.

The literature-based theory held up well against the empiric data collected in this study. Therefore, the authors did not modify that theory and instead developed three new demi-regularities (recurring patterns in data when conducting realist work) that add detail and nuance to their previous understanding of this model. These new demi-regularities focus on (i) expounding on how deliberate actions of CCCs focus more on resident development than on resident entrustment; (ii) elucidating that effortful work is not only about reconciling a paucity of data or incongruent data but also working hard to 'do the right thing' for residents; and (iii) describing how programs consider bias, equity and fairness, with a wide range of intentionality from being reactive to being proactive.

This study offers evidence of deliberate CCC efforts to support resident development. Moving forward, a similar focus should be more consistently placed on equitable entrustment and advancement decisions to balance both of these foundational goals.

Diversity competence, diversity itself, and a corresponding awareness of possible (intersectional) discrimination mechanisms have not been anchored in the German National Competence based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog 2.0., NKLM) yet, highlighting a systemic gap in national competency frameworks. We present our first experience with a prospective diversity-specific intervention in medical students to assess its short-term impact on students' diversity acceptance (DA) and to develop actionable recommendations for integrating diversity into medical education.

We designed a prospective cohort study using a control group (CG) and intervention group (IG) design. The IG absolved a five-day diversity-specific intervention (50 h; field trip; seminar). Quantitative data were collected using the validated DWD-O5 scale at baseline (T0), three months (T3), and six months (T6), complemented by qualitative responses (diversity issues in the medical curriculum; perceptions and criticisms) categorized using Mayring's content analysis. Descriptive and non-parametric statistics were performed.

Thirty-one medical students (n = 10, IG vs n = 21, CG) were enrolled. The IG demonstrated a short-term improvement in diversity competence (+ 9.72%) across all DWD-O5 factors during the intervention. While scores slightly declined at T6, they remained above baseline levels. 35% (CG) vs. 56% (IG) have experienced discrimination in context of medical studies on their own. Participants in both groups stressed the importance of integrating diversity criteria into curricula at an early stage (100% agreement). Findings revealed three key themes: perceived inadequacies in current curricula, self-reported discrimination experiences, and a strong desire for practical diversity training, such as simulation-based learning.

The intervention shows promise as an initial step toward addressing diversity gaps in medical education. By combining historical, cultural, and experiential learning approaches, the program fosters essential competencies such as empathy, self-reflection, and bias recognition. More broadly, sustained improvements in diversity competence require longitudinal integration of diversity training across curricula and systemic reforms to national frameworks like the NKLM. Future research should explore the long-term impact of such interventions and strategies for institutionalizing equity-focused medical education.

The total calcification score (TCS) is a visual rating scale to measure primary familial brain calcification (PFBC)-related calcification severity on CT. We investigated the inter- and intrarater agreement of a modified TCS.

Patients aged ≥18 years with PFBC or Fahr syndrome who visited the outpatient clinic of a Dutch academic hospital were included. The TCS was modified, for example, by adding hippocampal calcification, and ranged from 0 to 95 points. Fifteen raters evaluated all CTs, of whom 3 evaluated the CTs twice. Their entrustable professional activity (EPA) level ranged from II (medical student) to V (neuroradiologist). Agreement was assessed by using the intraclass correlation coefficient (ICC) for the total score. Kendall's W and weighted Cohen κ were used to determine the inter- and intrarater agreement for individual locations, respectively.

Forty patients were included (mean age 60 years, 53% women). The median modified TCS was 34 (range 4-76). For all EPA levels, the interrater agreement of the modified TCS was excellent (ICC = 0.97 [95% CI 0.95-0.98]). The Kendall W values were good to excellent for commonly affected locations, but poor to moderate for less commonly affected locations for raters with lower levels of expertise. The intrarater agreement of the modified TCS was excellent. The Cohen κ of most locations were substantial to almost perfect.

The modified TCS can be used with excellent reproducibility of the overall amount of brain calcifications and with limited training, although for some individual calcification locations more expertise is needed.

Several challenges regarding Clinical Competency Committee (CCC) processes have been previously reported. Few studies have addressed the cost of assessment in healthcare professional education. This study aimed to assess the time spent on and the cost of CCC processes, and faculty perception of the Milestones assessment in three residency programs.

We surveyed CCC faculty members to capture time devoted to, and satisfaction with, CCC processes from three residency programs at the University of Michigan: Anesthesiology, Emergency Medicine, and Surgery. During preparatory periods before CCC meetings, administrative staff used daily logs to record time spent in the CCC preparatory period to develop meeting documents and resident reports. CCC faculty members supplied estimated time spent preparing residents' assessments through a survey administered the day following the meeting. Additionally, the duration of each CCC meeting was recorded, and salaries were confirmed to estimate total cost. Total faculty and staff time was summed and reviewed by each departmental CCC program director.

CCC members found the unstandardized semi-annual report compiled by the programs was poorly organized, not easy to review, and did not provide high-quality information for setting Milestones. The majority of CCC members reported the current CCC process does not allow enough time for review of resident data, does not provide valuable feedback to inform resident progression, and does not provide adequate rigor to defend CCC decisions. Annually, administrative staff spent 162.9 ± 151.7 h preparing the reports. Faculty spent 147.0 ± 78.4 h for the resident assessment preparation and 97.3 ± 24.1 h in CCCs meeting. Based on salaries, the cost of CCC processes for Milestone assessment totaled USD83,437, with USD22,776, USD31,764, and USD28,897 for Anesthesiology, Emergency Medicine, and Surgery, respectively. With an average of USD395.44 per resident, the total annual CCC cost for University of Michigan Medical was extrapolated to be USD404,531.

Though Milestones were implemented more than ten years ago, CCC processes are still unsatisfactory to faculty and pose a significant institutional cost. Alternative approaches are still needed to improve resident competency assessment processes.

Social skills (e.g., assertiveness, empathy, ability to accept criticism) are essential for the medical profession and therefore also for the selection and development of medical students. However, the term "social skills" is understood differently in different contexts. There is no agreed upon taxonomy for classifying physicians' social skills, and skills with the same meaning often have different names. This conceptual ambiguity presents a hurdle to cross-context communication and to the development of methods to assess social skills. Drawing from behavioral psychology, we aim to contribute to a better understanding of social skills in the medical context. To this end, we introduce a theoretically and empirically informed taxonomy that can be used to integrate the large number of different social skills. We consider how skills manifest at the behavioral level to ensure that we focus only on skills that are actually observable, distinguishable, and measurable. Here, behavioral research has shown that three overarching skill dimensions can be seen in interpersonal situations and are clearly distinguishable from each other: agency skill (i.e., getting ahead in social situations), communion skill (i.e., getting along in social situations), and interpersonal resilience (i.e., staying calm in social situations). We show that almost all social skills relevant for physicians fit into this structure. The approach presented allows redundant descriptions to be combined under three clearly distinguishable and behavior-based dimensions of social skills. This approach has implications for the assessment of social skills in both the selection and development of students.

To evaluate the implementation of a longitudinal assessment framework utilizing entrustable professional activities (EPAs) in dental education during the initial 2-year implementation.

The Consolidated Framework for Implementation Research was utilized to evaluate contextual factors influencing implementation across the following domains: innovation, outer setting, inner setting, individuals, and process. Purposive sampling was used to ascertain a diverse pool of participants and various perspectives. Inclusion criteria required engagement for >12 months at the time of the study. A semi-structured interview guide was developed. Two focus groups of faculty and staff and four individual leadership interviews were conducted via Microsoft Teams, transcribed, and thematic analyses were performed using MAXQDA.

Fifteen participants described innovation design details, adaptability, complexity, and relative advantage. The contextual fabric of the setting was evaluated, highlighting the influence of the pandemic, institutional culture, structural shifts, and the pivotal role played by champions. The implementation process was investigated with a focus on training, engagement, access to information, faculty capability, motivation, learner experience, and continual assessment of implementation processes. Data suggests the framework was multi-dimensional, evolving, and learner-centered. It facilitated early identification of learners requiring support, provided comprehensive information guiding entrustment and practice readiness decisions and demonstrated preliminary evidence of effectiveness of the innovation.

Engaging in longitudinal assessment using EPAs is multifaceted and influenced by implementation context and intrinsic motivation prevalent among faculty members. The study identifies areas for refinement in support of continuous quality improvement and implementation of this innovative assessment framework in dental education, including technological support, training, and ongoing alignment.

To explore advanced pharmacy practice experience (APPE) preceptor perspectives including implementation recommendations, barriers, and facilitators to using entrustable professional activity (EPA) assessment in pharmacy experiential education.

Two 90-min virtual focus group sessions were conducted to elucidate preceptor perspectives on EPA integration into APPEs through semistructured discussion. Preceptors with experience utilizing entrustment-supervision scales with EPAs for assessments for at least 4 APPE learners in the last year were eligible. The primary outcome was a description of implementation guidance for assessing learners using an EPA framework. Secondary outcomes include descriptions of barriers and facilitators to using an EPA framework in APPE learner assessment. All sessions were recorded, transcribed, and analyzed using inductive thematic analysis.

Eleven APPE preceptors representing 9 institutions participated. Commonly identified implementation recommendations were regular, repetitive preceptor education using case practice vignettes, student orientation to assessment expectations, clear delineation of minimum competency level, frequent discussions with preceptors, and use of institutional resources. Identified barriers were the abstractness of entrustability, subjectivity of the entrustment-supervision scale and preceptor assessments, unclear grading schemes, length and complexity of the assessments, and EPA applicability to the specific practice setting. Commonly identified facilitators were clearly defined scales and expectations, preceptor education, student education, pass/fail grading schemes, and shorter, more frequent assessments.

EPA-based assessments can be used by preceptors for workplace-based assessments during APPEs. Faculty/preceptor development and student orientation with benchmarking and clear expectations are needed to support implementation.

Mental health nurses are often responsible for assessment/management of inpatient aggression. Validated instruments such as the Dynamic Appraisal of Situational Aggression (DASA), can aid risk assessment. However, limited attention has been paid to evaluating nurses' ability to administer risk assessment instruments. An entrustable professional activity may offer way of evaluating risk assessment clinical activities. DASA trainers' perceptions of the value and utility of an EPA were explored via collection of data through focus groups, with 17 participants from six countries. Thematic analysis was conducted to analyze the data. Three themes were interpreted: (1) DASA trainers-a way of knowing and being (2) An EPA-something you did not know you need until you see it; (3) The DASA-EPA supports the need for training and importance of integrity in assessment. Trainers engaged in innovative ways to ensure training is suitable and responsive to needs of nurses and their setting. Participants understood how an EPA could be used to evaluate DASA administration, monitor DASA use, provide feedback, and highlight the importance of training to ensure best practice.

Competencies-based education has gained global recognition, emphasizing the need for educators to align educational outcomes with healthcare system requirements. However, limited literature exists on competency frameworks and Entrustable Professional Activities (EPAs) specific to health professions educationists, hindering the development of tailored Master's programs.

This study aimed to develop a competency framework outlining the roles and functions for Master's learners in Health Professions Education (MHPE) and identify the key EPAs that form the foundation of a task-based MHPE curriculum, along with the expected levels of entrustment.

An international Delphi study was conducted involving three rounds of surveys and qualitative discussions with an expert panel of health professions educationists from diverse contexts (n = 29). The Delphi technique, including open-ended and quantitative rating scales, was employed to reach consensus on the EPAs and their levels of entrustment. The final list of EPAs was validated using the EQual rubric.

A total of 16 EPAs were identified and validated, mapped to core and potential roles and functions of health professions educationists. There is less agreement on the level of entrustment that should be attained at the master level, resulting in EPAs that must be fully entrusted before graduation and others which need further development afterwards.

The study presents a comprehensive competency framework and a set of EPAs tailored for MHPE programs, providing a structured approach to curriculum design and learner assessment. The findings underscore the importance of incorporating context-specific considerations and aligning educational objectives with the evolving roles and responsibilities of health professions educationists.

A holistic architectural education is the culmination of learning knowledge, skills, attitudes, and values, which eventually reflects in the quality of graduates. Even though different schools of thought have made various kinds of qualitative contributions towards the evolution of architectural education in India, it has largely been dominated by the quantitative and technical aspects of its regulating framework. Architects engage with the demanding contradictions between responsibilities of an ethical nature, the dynamic challenges of practice, and the intricacies of architectural imagination. The aesthetical and imaginative foundations of the field make it incumbent upon the architects to possess a balance of ecumenical proficiencies for accountability and personalization. The purpose of the study is to identify relevant attributes of Competency Based Education (CBE) that can be adopted for architectural education in India.

This research follows a narrative review approach and a descriptive-analytic method to broadly understand the attributes of CBE and its potential relevance to architectural education in India. 323 articles were searched on various search strings based on their relevance to the inquiry. 76 documents written in English language were included and appraised through the Scale of the Assessment for Narrative Review Articles (SANRA) tool to avoid any risk of bias. The PRISMA 2020 checklist and flow diagram has been used to report the findings of this narrative review.

The study identifies eight critical parameters of CBE with respect to its definitions, origins, transitions, regulatory environment, characteristics, approaches and implications on teaching-learning, frameworks and models of assessment; and challenges, which makes a case for the relevance of CBE for architectural education in India, which hasn't been explored yet.

The broader expectations of 'being competent' can be addressed through a conscious adoption of strategies of relevant attributes of CBE which can encourage building attitudes and temperament for life-long learning.

This study aimed to develop a tailored EPA framework for novice nurses to support their integration and performance in hospital settings.

Novice nurses often struggle with the transition from education to practice due to the gap between theoretical knowledge and practical skills. EPAs help bridge this gap by defining and assessing key competencies, but a framework specific to novice nurses is needed to address their unique challenges.

A modified Delphi method was used.

Conducted from October 2023 to March 2024, the study followed a four-stage process: team formation, identification, revision and evaluation of EPAs. Initial EPAs were identified through literature reviews, clinical guidelines and focus groups, then refined using the EQual rubric. Two Delphi rounds were conducted for validation. Experts rated the importance of EPAs in the first round, followed by online discussions, with the second round focusing on dimensions including Focus, Observable, Realistic, Generalizable and Multiple competencies.

The final framework included 12 EPAs: 1) Manage Admission and Discharge, 2) Provide Basic Care, 3) Collect Specimens, 4) Administer Medications, 5) Perform Non- Medication Therapies, 6) Monitor Conditions, 7) Respond to Emergencies, 8) Educate Patients, 9) Prevent Adverse Events, 10) Conduct Handovers, 11) Document Care and 12) Operate Equipment.

This EPA framework integrates theory and practice to improve training and assessment. Future research should focus on its implementation and refinement in diverse clinical settings to ensure broader applicability.

Entrustable professional activities (EPAs) have seen widespread adoption in medical education and other health professions education. EPAs aim to provide a bridge between competency-based education and clinical practice by translating competencies into fundamental profession-specific tasks associated with clinical practice. Despite the extensive use of EPAs in health professions education, EPAs have yet to be introduced into chiropractic education. The purpose of this paper is to describe the development and introduction of EPAs as part of 2 community-based chiropractic student preceptorship education programs in the United States.

EPAs were developed and introduced at 2 community-based chiropractic preceptorship sites in 5 distinct steps: (1) differentiating EPAs from competencies, learning objectives, and knowledge, skills, and attitudes; (2) identifying EPAs; (3) mapping EPAs to competencies and necessary experience, knowledge, and skills; (4) designing EPA assessment strategies; and (5) implementing the use of EPAs.

A total of 13 individual EPAs were developed and mapped to Council on Chiropractic Education meta-competency outcomes and underlying experience, knowledge, and skills. Three assessment tools were created to evaluate student entrustability for EPAs and enhance student self-assessment. The EPAs and assessment tools were integrated into chiropractic student preceptorships at each site.

This paper describes the development and introduction of EPAs at 2 community-based chiropractic preceptorship sites. Future research is needed to develop and standardize EPA use and assessment, and to evaluate outcomes associated with EPA use.

Near-peer tutoring (NPT) programs greatly prepare tutors for future teaching roles. However, without a comprehensive curricular framework, institutions may not adequately track the knowledge and skills tutors gain from these programs. We propose a competency-based peer-assisted coaching and tutoring (ComPACT) framework that captures tutors' progression as educators and supports their training through a community of practice. This framework leverages specialized teaching paths, digital micro-credentials, and a recognition system to track skill development. Overall, the ComPACT model is designed to create NPT programs that provide as much value to tutors as they do to the students they teach.

Since 1991, there have been significant changes in medical education in Georgia. Key changes include adapting national legislation toward international standards, establishing the National Center for Education Quality Enhancement (NCEQE), which was recognized in 2018 by the World Federation for Medical Education (WFME) as an accrediting agency and opening the Association for Medical Education in Europe (AMEE) International Networking Center in 2019. Undergraduate medical education, regulated by the Ministry of Education, Science and Youth of Georgia, spans six years. MD graduates then have options for further career paths, including working as junior doctors, residency, and/or pursuing PhD research.The main challenges the country presently faces are: the need to reduce the increasing number of (mainly) private medical schools. Recent updates to the national standards for undergraduate medical education have imposed stricter accreditation requirements for MD programs, resulting in the closure of schools that fail to meet these standards;postgraduate medical education is governed by the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs of Georgia (MOH) and needs further reform due to limited and paid residency positions;continuous professional development (CPD) was optional until recently, which led to an increase in professional inaccuracy and malpractice cases. To address this, regulatory bodies, including the MOH and professional associations, are preparing the legal basis for introducing compulsory CPD.

The purpose of this analysis was to identify, analyze, and report patterns (or themes) of planning and preparation considerations of students that scored less than the historic average score on the Pre-NAPLEX® exam.

This qualitative study was a retrospective, inductive thematic analysis of de-identified semi-structured interview field notes collected from student interviews for those students that scored less than the historic average score on the Pre-NAPLEX® exam.

Ninety-one students were initially contacted based on their score on the Pre-NAPLEX® exam to participate in one-on-one virtual discussions (i.e., interviews) with faculty members. Fifty-two responded and participated with their responses analyzed and included in thematic categorization. Four major themes were identified during the analysis. These include 1) Organization and Messaging of NAPLEX® Preparation Efforts, 2) Time Management during Competing Obligations, 3) Test Taking Experience, and 4) Curricular Disconnect.

Student performance on the NAPLEX licensing exam is of great concern to many colleges of pharmacy. As a result, many institutions are looking at root-causes for poor performance and working to implement structural changes at their institution to address these concerns. This investigation identified four major themes surrounding the preparation and planning for the Pre-NAPLEX® for students that scored less than the historic average score on the Pre-NAPLEX®. These include 1) Organization and Messaging of NAPLEX® Preparation Efforts, 2) Time Management during Competing Obligations, 3) Test Taking Experience, and 4) Curricular Disconnect. Each of these themes provides potentially actionable items to improve how students prepare and plan for the Pre-NAPLEX®, which may be translatable to informing actions to improve results on the actual NAPLEX exam itself.

Background The medical workplace presents challenges for workplace-based learning. Structured debriefing of shared clinical experiences has been proposed as a way to take advantage of workplace-based learning in a setting that facilitates deep learning conversations. Objective To investigate faculty and learner acceptance of private, face-to-face, structured debriefing of performance of entrustable professional activities (EPAs). Methods During the 2020-2021 academic year, faculty at the University of Colorado (CU) and the University of Utah (UU) debriefed fellow performance of jointly selected EPAs in neonatal-perinatal medicine pertinent to shared 1- to 3-week clinical rotations. Private face-to-face debriefing was structured by a comprehensive EPA-specific list of behavioral anchors describing 3 levels of entrustment/accomplishment. Sessions ended with joint decisions as to level of entrustment/accomplishment and goals for improvement. We used thematic analysis of semistructured fellow interviews and faculty focus groups to identify themes illustrated with representative quotations. Results We interviewed 17 fellows and 18 faculty. CU participants debriefed after clinical rotations; UU usually debriefed during rotations. Debriefing sessions for 1 to 2 EPAs lasted 20 to 40 minutes. Themes represented in fellow interviews and faculty focus groups suggested that debriefing facilitated formative feedback along with shared understanding of clinical performance and assessment criteria. The standardized format and private conversations supported assessment of aspects of performance for which review might otherwise have been overlooked or avoided. The conversations also provided valuable opportunities for formative discussion of other matters of importance to fellows. Conclusions Structured debriefing of recently shared clinical experiences fostered formative assessment viewed positively by teachers and learners.

Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible.

How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability.

How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise.

A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given.

The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity.

Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

To communicate how the Dutch postgraduate nursing education landscape was redesigned using entrustable professional activities (EPAs). The goal of this initiative was to reduce training time, enhance transfer across nursing specialities and contribute to a better-aligned continuum of initial education, postgraduate education and continuing professional development.

Nursing shortages continue to worsen worldwide. An approach to address this growing shortage is to create a more flexible postgraduate training structure, offering training in the just-in-time and just-as-needed models. EPAs can be used as building blocks for training and assessment. Experience with EPAs (i.e. units of professional practice that can be entrusted once a trainee has demonstrated the required competencies) in health professions education, including nursing, is rising rapidly. While EPAs are largely used to create training flexibility within a programme, they can also be used to create flexibility across programmes. In 2018-2022, training hospitals and education institutions in the Netherlands collaborated in the CZO Flex Level Project to redesign the postgraduate nursing education landscape using EPAs.

The implementation of a flexible postgraduate nursing education model nationwide will face several challenges. An overview of these challenges and suggestions for future research on the effects of the new structure on nursing competence, satisfaction and career development are provided.

EPAs can imbue flexibility within and across training programmes. Designing an EPA-based educational landscape requires nationally coordinated efforts.

Redesigning educational structures to allow for more flexibility is critical to address major societal challenges in healthcare.

Entrustable professional activities (EPAs) are units of professional practice that could be observed, assessed, monitored, documented, and entrusted. EPAs when entrusted, outline the physician's qualifications, and shape the scope of practice. This insight highlights the importance of development of EPAs in all medical specialties including dermatology to ensure the best standards for patient's care. Development of EPAs-based training program is considered a challenge for clinical educators. In this paper, we describe practical tips and reflections on our experience in developing EPAs in dermatology doctoral training program that could be a guide for dermatology educators to implement EPAs in dermatology training programs.

In transitioning to competency-based surgical training, the need to clearly define competency is paramount. The purpose of this study is to define the well-prepared foundational resident using the ACGME General Surgery Milestones as our conceptual framework.

Participants reflected on their expectations of a well-prepared resident at the end of PGY1, then assigned milestone levels reflecting this level of competence for General Surgery Milestones 1.0 and 2.0. Subcompetency scores were averaged among residents and faculty. The level of the well-prepared foundational resident was determined based on the highest level within one standard deviation of faculty, resident, and total group averages.

This took place during a dedicated education retreat at a single, large academic general surgery residency program.

Key faculty stakeholders and a representative sample of residents (PGY 1-5) within our institution participated.

Eight faculty and five residents completed Milestones 1.0 and 2.0 scoring. Mean scores between faculty and residents were compared. For 1.0, mean scores for Practice-Based Learning and Improvement 3 (PBLI 3) and Interpersonal Communication Skills 3 (ICS 3) were discernably lower for residents than for faculty (PBLI 3 1.3 (0.3) v 0.9 (0.2), p = 0.01; ICS3 1.6 (0.6) v 1.1 (1), p = 0.01). Scores of 2.0 were comparable across all subcompetency domains. With this broad agreement, Milestone-based competency standards were determined. Descriptive narratives of the KSAs were created for each subcompetency, combining the determined Milestones 1.0 and 2.0 levels.

We were able to clearly define the competent foundational resident using the ACGME Milestones as a conceptual framework. These Milestone levels reflect the culture and expectations in our department, providing a foundation upon which to build a program of assessment. This methodology can be readily replicated in other programs to reflect specific expectations of the program within the larger ACGME frameworks of competency.

In the Netherlands, the demand for veterinarians and veterinary nurses (VNs) working within referral care is rapidly growing and currently exceeds the amount of available board-certified specialists. Simultaneously, a transparent structure to guide training and development and to assess quality of non-specialist veterinarians and VNs working in a referral setting is lacking. In response, we developed learning pathways guided by an entrustable professional activity (EPA) framework and programmatic assessment to support personalised development and competence of veterinarians and VNs working in referral settings. Between 4 and 35 EPAs varying per discipline (n = 11) were developed. To date, 20 trainees across five disciplines have been entrusted. Trainees from these learning pathways have proceeded to acquire new EPAs in addition to their already entrusted set of EPAs or progressed to specialist training during (n = 3) or after successfully completing (n = 1) the learning pathway. Due to their outcome-based approach, the learning pathways support flexible ways of development.

The real-world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why?

Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full-text review of a subset of screened papers. Data extraction focused on developing context-mechanism-outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs.

PEDM is often driven by default (non-deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes.

PEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM.

Echocardiography education involves the teaching and assessment of multiple competencies to ensure work-ready graduates. To connect these competency standards to professional practice, it is important that the industry expectation around specific entrustable professional activities (EPAs) is determined. In Australia, echocardiography examinations are eligible for Medicare reimbursement when performed by sonographers listed on the Australian Sonographers Accreditation Registry (ASAR), either as an Accredited Medical Sonographer or as an Accredited Student Sonographer. A key criterion for acceptance onto the registry is the completion of, or active enrolment in, an accredited cardiac sonography course. Eligible courses apply for accreditation and are assessed by ASAR against their Standards for Accreditation of Sonographer Courses. This study sought to investigate the existing cardiac EPAs and provide insights into the industry's expectations for graduate cardiac sonographers in Australia.

Using an anonymous online survey tool, an invitation to participate was circulated via professional sonography groups and social media platforms. Accredited Medical Sonographers, Accredited Student Sonographers or interested stakeholders (academic, employer, medical specialist) working in Australia or New Zealand were invited to complete the survey. Survey questions were structured around the existing EPAs and knowledge items described in published sonography competency documents. Participants were asked if each individual EPA should be considered appropriate at the threshold of graduation, or at a higher level following a period of working in the profession.

There were 211 cardiac sonographers who completed the survey. The majority of respondents (148 of 211, 72.2%) indicated that the current EPAs should be updated. At 80% agreement, the following EPAs were considered essential for the graduate: left ventricular structure and function, right ventricular structure and function, atrial size, valvular disease, systemic hypertension, cardiomyopathies, diseases of the aorta, coronary artery disease, pulmonic hypertension, and basic congenital heart disease. This list is more extensive than the current ASAR-endorsed EPAs, and the findings in this research will guide the revision of current ASAR-endorsed EPAs for graduate-level cardiac sonography.

The results of this study show Accredited Medical Sonographers completing a cardiac sonography course in Australia should be entrusted to perform a wide range of examinations however, greater alignment between educational providers, ASAR and industry is still required.

Entrustable Professional Activities (EPA)-based assessment is easily and intuitively used in evaluating the learning outcomes of competency-based medical education (CBME). This study aimed to develop an EPA for occupational therapy focused on providing health education and consultation (TP-EPA3) and examine its validity.

Nineteen occupational therapists who had completed online training on the EQual rubric evaluation participated in this study. An expert committee identified six core EPAs for pediatric occupational therapy. TP-EPA3 was developed following the EPA template and refined through consensus meetings. The EQual rubric, a 14-item, five-point criterion-based anchor system, encompassing discrete units of work (DU), entrustable, essential, and important tasks of the profession (EEIT), and curricular role (CR), was used to evaluate the quality of TP-EPA3. Overall scores below 4.07, or scores for DU, EEIT, and CR domains below 4.17. 4.00, and 4.00, respectively, indicate the need for modifications.

The TP-EPA3 demonstrated good validity, surpassing the required cut-off score with an average overall EQual score of 4.21 (SD = 0.41). Specific domain scores for DU, EEIT, and CR were 3.90 (SD = 0.69), 4.46 (SD = 0.44), and 4.42 (SD = 0.45), respectively. Subsequent revisions clarified observation contexts, enhancing specificity and focus. Further validation of the revised TP-EPA3 and a thorough examination of its reliability and validity are needed.

The successful validation of TP-EPA3 suggests its potential as a valid assessment tool in occupational therapy education, offering a structured approach for developing competency in providing health education and consultation. This process model for EPA development and validation can guide occupational therapists in creating tailored EPAs for diverse specialties and settings.

Designing competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings.

A qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health.

The supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies.

The study results support the Ministry of Health's policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health's three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

Entrustable professional activities (EPAs) are a crucial component of contemporary postgraduate medical education with many surgery residency programs having implemented EPAs as a competency assessment framework to assess and provide feedback on the performance of their residents. Despite broad implementation of EPAs, there is a paucity of evidence regarding the impact of EPAs on the learners and learning environments. A first step in improving understanding of the use and impact of EPAs is by mapping the rising number of EPA-related publications from the field of surgery. The primary objective of this scoping review is to examine the nature, extent, and range of articles on the development, implementation, and assessment of EPAs. The second objective is to identify the experiences and factors that influence EPA implementation and use in practice in surgical specialties.

Scoping review. Four electronic databases (Medline, Embase, Education Source, and ERIC) were searched on January 20, 2022, and then again on July 19, 2023. A quasi-statistical content analysis was employed to quantify and draw meaning from the information related to the development, implementation, assessment, validity, reliability, and experiences with EPAs in the workplace.

A total of 42 empirical and nonempirical articles were included.

Four thematic categories describe the topic areas in included articles related to: 1) the development and refinement of EPAs, including the multiple steps taken to develop and refine unique EPAs for surgery residency programs; 2) the methods for implementing EPAs; 3) outcomes of EPA use in practice; 4) barriers, facilitators, and areas for improvement for the implementation and use of EPAs in surgical education.

This scoping review highlights the key trends and gaps from the rapidly increasing number of publications on EPAs in surgery residency, from development to their use in the workplace. Existing EPA studies lack a theoretical and/or conceptual basis; future development and implementation studies should adopt implementation science frameworks to better structure and operationalize EPAs within surgery residency programs.