Entrustable Professional Activities (EPAs) are defined as essential, observable, and measurable tasks or responsibilities that a trainee can be entrusted to perform independently once they demonstrate sufficient competence. As a cornerstone of competency-based medical education, EPAs offer a structured framework to assess readiness for independent practice by focusing on actual professional activities rather than abstract competencies. This study aimed to evaluate the perceptions, awareness, and implementation challenges of EPAs among faculty and trainees in postgraduate dental programs. By exploring their experiences, this research provides valuable insights into how EPAs can enhance competency-based education while identifying barriers and opportunities for improving their integration into dental training curricula.
The closed-ended responses in this study highlight a general agreement on the significance of EPAs as a structured framework for CBE. A substantial proportion of both faculty and trainees acknowledged that EPAs facilitate competency development, aligning with the findings of Wolcott et al. [15], who reported that EPAs clearly outline work tasks expected of graduates. Faculty members in our study emphasized the importance of prior training, with 63% strongly agreeing that it is necessary for effective EPA implementation. Similarly, Quinonez et al. [16] emphasized the role of faculty training and institutional support as critical factors for successful implementation. However, logistical challenges were evident, with 39% of faculty reporting technical difficulties. These challenges resonate with findings from Ali et al. [14] where 35% of dental trainees indicated that being observed adversely affected their performance. The varying supervision levels required across different EPAs, as observed in longitudinal studies like that of Andreou et al. [17], further complicate implementation. These findings underscore the need for institutional support, technological resources, and calibrated faculty training. A notable discrepancy emerged in perceptions of resource adequacy, with only 28% of faculty strongly agreeing that sufficient support is available. This aligns with the findings of Wolcott et al. [15], who identified time constraints and faculty calibration as barriers to EPA adoption. Addressing these issues is imperative to enhance the utility of EPAs in postgraduate training programs.
Thematic analysis of open-ended responses revealed diverse perspectives on feedback and observation. Trainees valued constructive feedback but highlighted challenges in time adequacy and personalization. Andreou et al. [17] similarly noted that high-quality feedback is integral to the success of EPAs, emphasizing the importance of actionable and task-oriented comments. In our study, Year III residents expressed dissatisfaction with feedback time, while Year IV residents found feedback constructive, reflecting variability in experience and expectations across training levels. Observation was another critical theme. While some trainees appreciated the developmental feedback provided through direct observation, others felt it hindered their performance. This sentiment echoes findings from Ali et al. [14], where 35% of trainees reported performance anxiety under observation. These insights highlight the need for a supportive observation environment that reduces stress and fosters learning. The integration of EPAs into the curriculum emerged as a significant concern, with only 10.7% of trainees strongly agreeing that EPAs are well-integrated. This finding contrasts with Quinonez et al. [16], who documented the adaptability and effectiveness of a longitudinal EPA framework in identifying learners requiring support. Institutional efforts to align EPAs with curricular goals and accreditation standards are essential for improving integration and utility. The findings of Ramaswamy et al. [18] further reinforce this perspective, illustrating how a Delphi-based consensus approach can refine and define EPAs that align with clinical expectations. Their study highlights the significance of iterative stakeholder feedback in constructing clear and measurable EPA statements, ensuring that these activities are both entrustable and reflective of real-world practice demands.
The findings of this study align with existing literature on the developmental value of EPAs. For instance, the focus on structured learning and assessment aligns with the work of Kelly et al. [19], who emphasized the potential of EPAs to bridge theoretical knowledge and practical application. However, significant challenges identified in this study, such as resource constraints and faculty readiness, contrast with studies in well-resourced settings, where robust support systems have facilitated smoother implementation. Andreou et al. [17]. highlighted discrepancies between feedback quality and entrustability scores, suggesting the need for standardized feedback practices. The longitudinal study by Schumacher et al. [20] demonstrated that only 53–98% of trainees achieved unsupervised practice levels by graduation, depending on the EPA. This variability underscores the need for continuous assessment frameworks to track trainee progress and identify curricular gaps. Schumacher et al. [20] also highlighted the importance of aligning performance standards with real-world practice readiness. In our study, the limited integration of EPAs into the curriculum similarly points to a need for systematic curricular enhancements to ensure practice readiness. To enhance the effectiveness of EPAs, several recommendations are proposed. Comprehensive faculty development programs should focus on EPA principles, assessment techniques, and feedback strategies. Faculty calibration sessions, as suggested by Wolcott et al. [15], can ensure consistency in assessments. Institutions must embed EPAs into the curriculum, aligning them with educational objectives and accreditation standards. Regular evaluations, combined with stakeholder feedback, can drive iterative improvements. Reducing stress associated with observation can improve trainee performance. Techniques such as formative assessments and supportive feedback sessions can foster a constructive learning atmosphere. Addressing logistical challenges requires institutional commitment to resource provision, including technological tools for tracking EPA progress and adequate staffing. Tailored, actionable feedback should be prioritized, and faculty training on delivering high-quality feedback, as highlighted by Andreou et al. [17], can improve trainee satisfaction and learning outcomes. Finally, longitudinal assessment frameworks, as described by Quinonez et al. [16] can identify learners requiring support and ensure practice readiness. A future direction for research should examine differences in EPA implementation across dental specialties, as variations in specialty-specific challenges and resource availability may influence the effectiveness and integration of EPAs into postgraduate curricula.
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