Student Perceptions of Narrative Feedback in Entrustable Professional Activities

Introduction

Entrustable professional activity (EPA) observations can be used to develop a holistic picture of trainee competency in professional tasks. Narrative feedback is an essential component of EPAs, but there is a lack of published literature capturing undergraduate student perceptions.

Methods

Students who completed Year 3 of the MD programme in 2022–2023 at one institution in Canada were invited to participate in a survey designed to elicit their perceptions of narrative feedback in EPAs. Survey methods included closed-ended questions (analysed descriptively) and open-ended questions (analysed through thematic analysis).

Results

The response rate to the survey was 23%. Over 60% of students reported that narrative comments in EPAs were specific and aligned with EPA scores, and 86% reported that the narrative feedback was individualised at least some of the time. However, 57% reported that they never or rarely received actionable feedback for growth. Students demonstrated mixed feelings as to whether EPAs help support their clinical development. Some noted that they can help students identify gaps and reinforce positives. Others reported preferring verbal feedback to written feedback and that EPAs resulted in an administrative burden. Over 90% of students reported barriers to obtaining EPAs, and almost 90% expressed the need for changes to EPAs. A predominant theme from students was the desire for a reduction in EPA requirements.

Conclusions

Students perceived the narrative feedback to be individualized and specific but reported that the feedback rarely contained feedback for growth. Students identified several barriers to EPA completion and provided recommended changes.