Student-led Entrustable Professional Activities in Clinical Practice from the Perspectives of Stakeholders

Abstract

In health curricula, clinical services may be deconstructed into basic tasks, called Entrustable Professional Activities (EPA’s). Obtaining a medication history as part of medication reconciliation (MedRec) is an example. Learners are trained to conduct EPA’s with minimal supervision in clinical practice once competent.

AIMS To explore the perspectives of stakeholders on EPA’s in different health disciplines from the literature and in clinical practice.

METHODS A meta-synthesis explored stakeholders’ views on the implementability of EPA’s. A qualitative study evaluated the MedRec program from the perspectives of pharmacy students and pharmacists through focus groups, interviews and reflective portfolios, coding themes based on Klaic et al.’s (2022) implementability framework. Quotes were synthesised under emerging themes of pre-implementation, implementation and reflections.

RESULTS The meta-synthesis included 14 studies from the literature. The perspectives of learners and preceptors (44 pharmacists, 114 students from one university) were also evaluated. During hospital placements, students were challenged by the ‘culture shock’ of the ‘real-world’ pertained to patient complexities, workload, workflow, workplace-related factors, and documentation process. Misalignment of preceptors’ expectations hindered them from entrusting learners to practise semi-independently. Nevertheless, students adapted to feedback and embraced challenges.

CONCLUSIONS EPA programs in clinical practice were viewed positively by stakeholders, however a number of barriers were also uncovered. Reflection on findings and involving preceptors in classroom activities, may allow universities to modify programs to better prepare students for the complex environment and allow preceptors to trust students’ abilities earlier. Preceptors and students are required to set realistic goals so that preceptors can control their workload pertaining to patient care whilst supporting students’ training.