Enhancing Alignment between Competencies and Clinical Workplace: Implementing Entrustable Professional Activities in the Flemish GP Training

Vasiliki Andreou, Sanne Peters, Jan Eggermont, Birgitte Schoenmakers

Keywords: workplace-based assessment, competency-based medical education, EPAs, competency development


Although competency frameworks have been rapidly gaining popularity in postgraduate medical education, early implementation attempts have revealed several obstacles. These obstacles include context dependency, language barriers and challenges in successfully integrating competencies in workplace settings. To address these obstacles, the concept of Entrustable Professional Activities (EPAs) has emerged.

Research question(s):

Are the EPAs appropriate for assessment in the workplace?


To bridge the gap between competencies and workplace, we developed an educational intervention based on EPAs for the Flemish GP Training. The EPAs functioned as learning outcomes for different assessment moments and types in the workplace. Initially, we developed a comprehensive list of 62 EPAs, each corresponding to different types of care and practices, commonly found in Primary Care. To ensure validity of the EPAs, we engaged in discussions with various GPs. The EPAs were integrated into the existing e-portfolio utilized by GP trainers and GP trainees for assessment in the workplace. To assess the implementation process, we used a longitudinal cohort design measuring the acceptability of the EPAs for both trainers and trainees at three different time points through surveys, consisting of close and open-ended questions. We analysed quantitative data with descriptive statistics, while we used content analysis for qualitative data.


Out of 600 trainers and trainees, 330 filled in the first survey, 235 trainers and 95 trainees. Answers from both groups indicated that the EPAs were deemed as acceptable for assessment in the workplace. Specifically, 42 trainees and 111 trainers thought that the EPAs were acceptable for assessment purposes. From the content analysis, we discerned three categories: 1. EPAs as novelty, 2. Need for additional training, 3. Importance of simplified supporting information.


Our early findings provide valuable insights into EPAs implementation. The need for ongoing support, training, and streamlined resources are of high importance to optimize their use.

Points for discussion:

1. Overcoming obstacles in the early implementation of educational interventions

2. Assessing competencies in clinical workplace

3. Lessons learned from implementing EPAs


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