Martin L, Sibbald M, Brandt Vegas D, Russell D, Govaerts M.
Assessment for and of learning in workplace settings is at the heart of competency-based medical education (CBME). In postgraduate medical education (PGME), entrustable professional activities (EPAs) and entrustment scales are increasingly used to assess competence. However, the educational impact of these assessment approaches remains unknown. Therefore, this study aims at exploring trainees' perceptions regarding the impact of EPAs and entrustment scales on feedback and learning processes in the clinical setting.
Four focus groups were conducted with postgraduate trainees in anesthesia, emergency medicine, general internal medicine, and nephrology at McMaster University in Hamilton, Ontario, Canada. Data collection and analysis were informed by principles of constructivist grounded theory.
EPAs representing a well-defined task are perceived as potentially effective drivers for feedback and learning. Use of EPAs and entrustment scales, however, may augment existing tensions between developmental (for learning) and decision-making (of learning) assessment functions. Three key dilemmas seem to influence the impact of EPA-based assessment approaches on residents' learning: 1) standardization of outcomes versus flexibility in assessment to align with individual learning experiences; 2) assessment tasks focusing on performance standards versus opportunities for learning; and 3) feedback focusing on numeric entrustment scores versus narrative and dialogue. Use of entrustment as an assessment outcome may impact trainees' motivation and feeling of self-efficacy, further enhancing tensions between learning and performance.
EPAs and entrustment scales may support assessment for learning in PGME, however, successful implementation requires the careful management of dilemmas which arise in EPA-based assessment in order to support competence development.