Entrustable professional activities for workplace assessment of general practice trainees

Objective: To assess whether entrustment levels for junior trainees with respect to entrustable professional activities (EPAs) increase over time; whether entrustment levels for senior trainees are higher than for junior trainees; and whether self-assessment of entrustment levels by senior trainees more closely matches supervisor assessment than self-assessment by junior trainees. Design, setting, participants: Observational study of 130 junior and 153 senior community-based general practice trainees in South Australia, 2017. Main outcome measures: Differences in entrustment levels between junior and senior trainees; change in entrustment levels for junior trainees over 9 months; concordance of supervisor and trainee assessment of entrustment level over 9 months. Results: Senior trainees were 2.1 (95% CI, 1.66–2.58) to 3.7 times (95% CI, 2.60–5.28) as likely as junior trainees to be entrusted with performing clinical EPAs without supervision. The proportion of EPAs with which junior trainees were entrusted to perform unsupervised increased from 26% at 3 months to 35% at 6 months (rate ratio [RR], 1.37; 95% CI; 1.15–1.63), to 50% at 9 months (RR, 1.92; 95% CI, 1.64–2.26), and 69% at 12 months (RR, 2.68; 95% CI; 2.32–3.12). At 3 months, the mean differences in entrustment ratings between supervisors and trainees was 5.5 points (SD, 6.6 points) for junior trainees and 2.93 points (SD, 2.8 points) for senior trainees (P < 0.001). Conclusions: EPAs are valid assessment tools in a workplace-based training environment.