An analysis of core EPAs reveals a gap between curricular expectations and medical school graduates' self-perceived level of competence

BMC Med Educ. 2021 Feb 16;21(1):105. doi: 10.1186/s12909-021-02534-w.


Background: Entrustable Professional Activities (EPAs) are being implemented worldwide as a means to promote competency-based medical education. In Switzerland, the new EPA-based curriculum for undergraduate medical education will be implemented in 2021. The aim of our study was to analyze the perceived, self-reported competence of graduates in 2019. The data represent a pre-implementation baseline and will provide guidance for curriculum developers.

Methods: Two hundred eighty-one graduates of the Master of Human Medicine program of the University of Zurich who had passed the Federal Licensing Exam in September 2019 were invited to complete an online survey. They were asked to rate their needed level of supervision ("observe only", "direct, proactive supervision", "indirect, reactive supervision") for 46 selected EPAs. We compared the perceived competence with the expected competence of the new curriculum.

Results: The response rate was 54%. The need for supervision expressed by graduates varied considerably by EPA. The proportion of graduates rating themselves at expected level was high for "history taking", "physical examination" "and documentation"; medium for "prioritizing differential diagnoses", "interpreting results" and "developing and communicating a management plan"; low for "practical skills"; and very low for EPAs related to "urgent and emergency care".

Conclusions: Currently, there are significant gaps between the expectations of curriculum developers and the perceived competences of students. This is most obvious for practical skills and emergency situations. The new curriculum will either need to fill this gap or expectations might need to be revised.

Keywords: Competency-based medical education; Entrustable professional activities; Self-assessment; Undergraduate medical education.