Entrustable Professional Activities use in Competency assessment in Al Ain Family Medicine Residency Program. Preliminary experience
Authors: AlKetbi Latifa Baynouna , AlZarouni Amal , AlNyadi Amna , AlKuwaiti Mariam , AlShamsi Noura , AlZaabi Mariam , AlNyadi Mariam , AlDhaheri Ruwaya , AlKuwaiti Mouza 
Published: October 2023

Abstract
Background:
In Competency-Based Medical Education, CBME era Entrustable Professional Activity (EPA) emerged as a successful framework to assess learner progression in achieving competency. This study describes EPAs use in the AlAin-Ambulatory Healthcare Services family medicine program and identifies the competency attainment of the residents in these EPAs.
Methods:
This is a retrospective cross-sectional study describing the experience of one program, the Al Ain-Ambulatory Healthcare Services Family Medicine Residency program. Accrediting bodies, the United Arab Emirates, the National Institute of Health Specialists, NIHS and the Accreditation Council of Graduate Medical Education-International, ACGME-I, the Clinical Competency Committee, CCC, require EPA and milestones reporting biannually at mid-year and at the end of any academic year for all residents in the program. The EPAs data from January 2022 until June 2023 were included in this study.
Twenty-nine EPAs were adapted in the program from the published family medicine EPAs in literature and piloted since 2018. Residents were assessed by their supervisors based on all performance data gathered in the program EPAs were approved in CCC meetings. A scale from 1 to 5 is used, with 4 being a performance score reflecting achieved competency or independent practice.
Results:
EPAs assessment data showed at least two-thirds of the residents achieved 4, competent, or 5, above expected competence, by the end of year 3. This has improved by mid-PGY4, with 10 EPAs being achieved by 84.6% of the residents, 12 other EPAs were achieved by two-thirds of the residents, and in five EPAs, 46.2% (6 residents) did not reach competency at midyear 4. The least achieved EPAs assessed near the end of training were “diagnose and manage mental health conditions,” where almost two-thirds of the graduates are not reaching unsupervised practice, the average attained in mid-year four was 3.4, and “managing end-of-life and palliative care,” none reached level 4, average attained in mid-year 4 of 2.1. During the initial year of postgraduate training, residents have made notable progress in foundational EPAs, taking histories, performing physical examinations, interpreting and choosing appropriate investigations, and providing preventive care. average attained in mid-year 2, reaching 3.5. The 4th year appears to be essential for further development of the EPAs, with significant growth noticed in PGY4 across all EPAs. Particularly the EPAs related to practice management and more complex skills and knowledge, as well as ones requiring more volume, variety, and continuity, such as mental health and complex care and medical emergencies. The t-test was significant for all EPAs in relation to their growth in the program through all points of assessments p<0.001.
Conclusions:
This study provides insight into EPA adaptation and implementation in a new context, the United Arab Emirates. It provides valuable guidance on EPA's use as well as highlighting gaps in specialty education and local practice.