School of Medical Sciences of the Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of General Practice of the Academic Medical Centre, Amsterdam, The Netherlands.
Perspect Med Educ. 2021 Aug;10(4):200-206. doi: 10.1007/s40037-021-00658-9. Epub 2021 Mar 31.
Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula.
For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs.
An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme.
Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.
可委托的专业活动（EPAs）在许多研究生医学教育（PGME）项目中应用方式不同，但造成这种差异的原因以及这种差异对 EPAs 应用的影响尚不清楚。我们的目的是研究工作环境如何影响 EPAs 的采用，以及当 EPAs 的采用受到影响时，EPAs 的工作效益在多大程度上受到风险。课程开发者可以利用这些知识，将 EPAs 应用于他们的课程中。
在这项定性研究中，我们选择了四个 PGME 项目：全科医学、临床老年医学、妇产科和放射学与核医学。对国家培训计划进行了文件分析，该计划得到了 AMEE 制定基于 EPA 的课程指南和相关 EPA 文献的支持。对专门参与课程开发的医学专家进行了访谈。采用内容分析法阐明了 EPAs 采用差异的可能原因。
EPAs 采用差异的一个重要原因可以解释为环境因素，例如患者人群、医生在医疗保健系统中的角色以及培训计划开展所在的当地医疗机构的设置。EPAs 采用差异具体反映在 EPA 的数量和广度，以及在 PGME 项目中执行委托决策的方式上。
由于 EPAs 采用的差异，学员在培训计划中独立工作的机会可能会受到挑战。EPAs 可以在 PGME 课程的课程中以有意义的方式实施，但前提是要评估 EPA 的质量，让未来的使用者参与到开发中，并保留 EPAs 的关键特征（委托决策）。
