Implementation of Core Entrustable Professional Activities in the Internal Medicine Clerkship: A Psychometric Study

Background

Entrustable professional activities (EPAs) have been proposed as a holistic approach to competency-based assessment. The 13 Core EPAs for Entering Residency (CEPAER) are essential tasks that a medical student should be trusted to perform with indirect supervision upon entering residency, based on demonstrated competence.

Objective

To study the validity and reliability of workplace-based assessments of the 13 core EPAs as measurements of medical student performance and growth over the Internal Medicine (IM) clerkship.

Design

Correlational-based population study.

Participants

A total of 398 third-year medical students at the University of Minnesota Medical School participated. Students were enrolled in a required 8-week IM clerkship during the 2023–2024 and 2024–2025 academic years. A total of 825 assessors provided EPA ratings with a mean number of 12 per assessor; SD = 15.08.

Main Measures

There were 10,034 EPA-based assessments collected (mean per student = 25; SD = 6.1). The most frequently assessed EPAs were EPA 6 (Provide an oral presentation of a clinical encounter; n = 1866; mean per student = 4.69), EPA 5 (Document a clinical encounter in the patient record; n = 1662; mean per student = 4.18), and EPA 2 (Recommend and interpret common diagnostic and screening tests; n = 1421; mean per student = 3.57).

Key Results

Regression analyses indicated statistically significant growth in entrustment scores for EPAs 1, 2, 3, 5, 6, 8, 10, and 12. Generalizability analysis showed that to achieve adequate reliability (Ep2 ≥ 0.80), at least 5 assessments were required to be conducted by 5 raters.

Conclusion

EPAs represent a valid and reliable measure for medical student growth during the IM clerkship, particularly for EPAs 1, 2, 3, 5, 6, 8, and 10.