Entrustable professional activities - the missing piece of the assessment jigsaw for UK undergraduate medical education? Is general practice the perfect place to start?

The Medical Licensing Assessment (MLA) has been introduced for all medical students obtaining a primary medical qualification in the UK from 2024/25. It tests 'the core knowledge, skills and behaviours needed to practise safely in the UK'. It does not, however, assess 'on the job' learning and performance in clinical practice. Undergraduate medical education's primary purpose is to prepare medical students for clinical practice. Preparedness for practice is enhanced by experiential learning in clinical settings. Evidence indicates that assessment drives learning and the existing MLA places little emphasis on assessment of experiential learning. This risks disincentivising and devaluing learning from complex real-world clinical encounters which are typical in primary care, the same learning enhances preparedness for practice. It is possible that there are gaps in the current focused and standardised MLA assessment strategy with potential for negative unintended consequences on learning in primary care and graduates' preparedness for practice. By addressing these gaps, there is scope to enhance the current MLA, ensuring more complete assessment and fostering graduate preparedness. We propose that, while there is potential for primary care to be negatively impacted by the MLA, it also provides the ideal setting for innovation to develop the 'missing piece' of the assessment jigsaw. We propose this could take the form of entrustable professional activities (EPAs), a relatively new assessment model that enables more meaningful assessment of prospective new doctors in real-world clinical settings. We set out challenges and opportunities associated with EPAs, particularly in undergraduate medical education in primary care.