Entrustable Professional Activities in an Intern Preparedness Course: Perceptions and Entrustment Decisions

Entrustable Professional Activities (EPA) have created a frameshift in undergraduate medical education. This retrospective cross-sectional study addressed the fourth-year medical students’ perceptions of their EPA knowledge and skills before and after the completion of the intern preparedness course (IPC) provided at the end of their medical curriculum. Pre- and Post-IPC survey and course debriefing data were used to assess students’ perception of their preparedness and comfort with performing EPAs before and after IPC. This study also studied the correlation between the faculty ad hoc entrustment decisions and the students’ observed behaviors on the OSCE checklist in the delivering bad news station. A total of 43 students and 17 students completed the pre and post IPC surveys respectively. The majority of the students were comfortable performing 10 of the 13 EPAs after participating in the intern preparedness course. There was a statistically significant increase in the comfort of the students obtaining informed consent for test after the completion of IPC. Students noted that there were opportunities to practice and receive feedback on all of the EPAs within the curriculum, but these depended in part on rotation, site, and faculty/residents. In the delivering bad news OSCE station, significant correlations exist between faculty ad hoc entrustment decision and specific observable behaviors in the checklist. Opportunities exist within the medical school curriculum to practice and receive feedback on all the EPAs, but experiences are variable and gaps remain. A boot camp experience can help fill the gaps and ensure that all students have the requisite skills. Assessment checklists can also help identify task behaviors that most strongly impact entrustment decisions. Curriculum developers need to plan carefully to embed the EPAs systematically in the curriculum.