A closer look at entrustment: A study into entrustment in workplace-based medical education, with a focus on EPAs and the role of contextual factors

Entrustable Professional Activities (EPAs) were introduced in Post Graduate Medical Education (PGME-) programs to support the use of competency-frameworks. EPAs describe activities being performed in daily clinical practice, the competencies required to perform the task are also included in the EPA. Evaluation of EPAs is done through an entrustment decision, evaluating the extent to which a trainee is allowed to work independently. Working independently during the course of a training program is vital for trainee development towards an independently functioning medical specialist.
In this thesis we conclude that contextual factors related to the medical specialty and the structure of the curriculum of the PGME-program do not only influence the implementation of EPAs in the curriculum, but also the usefulness of EPAs for trainee learning, assessment, and the safe entrustment of patient care to trainees.
Longitudinal rotations, in which trainers and trainees work together for an extended period of time, increase opportunities for trainees to work independently, while in the same time positively stimulating trainee learning and assessment. EPAs can enhance this value of longitudinal rotations, since assessment and entrustment may be substantiated with feedback resulting from the EPAs. The other way around, the value of EPAs can be increased, since trainers and trainees work together for a longer period of time, resulting in them being better attuned to each other and also having better overview of trainee learning.