Marije P Hennus, Roberta I Ladenheim, H Carrie Chen, Fremen Chihchen Chou, Stanley J Hamstra, Eva K Hennel, Adrian P Marty, Gustavo S Romao, Mabel Yap, Olle Ten Cate
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引用次数: 0
Abstract
Competency-based medical education (CBME) is widely adopted in numerous countries, but many programs struggle to translate its conceptual promises into routine educational and clinical practice. Entrustable Professional Activities (EPAs), a key mechanism to operationalize CBME, have been implemented in different ways with substantial variation across contexts. While implementation challenges are well described, the field lacks explanatory approaches to understand why such variation occurs and how it shapes practice. In this Show-and-Tell contribution we apply Normalization Process Theory (NPT), an implementation theory, to analyze how EPA-based curriculum reforms are taken up, enacted, and sustained across settings. We conducted a comparative, theory-informed analysis of implementation experiences from five regions (in Latin America, Asia, North America, Europe) drawing on materials from an international EPA symposium (Barcelona, 2025). Data sources include a pre-symposium survey, invited presentations, transcripts of plenary discussions, and follow-up reflections. Using NPT's four core constructs (coherence, cognitive participation, collective action, and reflexive monitoring), we examined how stakeholders make sense of EPAs, engage with implementation, integrate practices into clinical routines, and adapt them over time. The analysis revealed recurring mechanisms shaping implementation across contexts. Challenges included conceptual ambiguity, variable engagement, workflow pressures, and misalignment with existing practices. At the same time, enabling conditions emerged across settings: clear communication of purpose, phased implementation strategies, coordinated faculty development, leadership support, and context-sensitive adaptation. By foregrounding implementation mechanisms rather than outcomes alone, NPT offers a transferable analytic lens to guide, evaluate, and refine curriculum reforms.
期刊介绍：
Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices.
Official journal of the The Netherlands Association of Medical Education (NVMO).
Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
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