Exploring the Failed Implementation of an Entrustable Professional Activities-Based Curriculum for Pediatric Residency: "It's What We Always Asked For, And Now Nobody Does It." A Qualitative Study.

Abstract

Background: Medical education has been experiencing a transition from time- to competency-based. Since their introduction by Olle ten Cate in 2005, entrustable professional activities are a part of this process. We implemented a set of EPAs for the first 3 years of training at our hospital, encompassed by informational materials for trainees and supervisors.

Objectives: Our objective was to assess barriers and facilitators for the implementation of entrustable professional activities in pediatric residency in a German tertiary hospital. Furthermore, our aim was to explore how they foster self-regulated learning and feedback, and to identify barriers and facilitators on the path to more confidence and safety.

Methods: We applied a qualitative approach with focus-group discussions (adhering to COREQ guidelines), 3 each with residents and supervisors. Focus groups were recorded, transcribed verbatim, and de-identified. Data analysis was conducted based on qualitative content analysis.

Results: Three months after the implementation, no resident had fulfilled the required assessments. In the discussions, we identified barriers to and facilitators of the process. Both may be attributed to internal and external factors. The concept was supported by residents and supervisors, but time, priorities in the clinical routine, lack of initiative, and an inhibition on the part of the residents to approach the supervisors were the main reasons for the concept to fail. We identified a higher degree of structure, as well as commitment and accountability, as possible facilitators.

Conclusion: Entrustable professional activities are a promising means of promoting self-regulated learning and a positive feedback culture to increase confidence and safety in clinical practice. Our findings expose the factors that disrupt or promote this process. Our data provide guidance for implementation in a setting with little experience with this tool.