Perceived consequences of Entrustable Professional Activities implementation on the clinical skills development of Family Medicine registrars: Observations and reflections

Abstract

Family medicine training in South Africa has shifted from traditional assessments to competency-based methods, including Entrustable Professional Activities (EPAs). Entrustable Professional Activities emphasise what learners can do rather than what they know, aligning with modern, more pragmatic pedagogical theories of praxis. At the University of the Witwatersrand’s Division of Family Medicine, implementation of EPAs has coincided with some potentially unintended consequences. Registrars performed poorly on Focused Objective Structured Clinical Examination (OSCE) stations during internal end-of-second-year examinations, indicating possible erosion of individual clinical skills and diagnostic precision. Using Gibbs’ Reflective Cycle, we analyse the emerging conflict among workplace-based entrustment decisions, the growing assessment burden and traditional competencies demonstrated in high-stakes examinations.
Contribution: This reflective article contributes to the literature by highlighting how EPA implementation may inadvertently undermine discrete clinical skills despite satisfactory workplace-based performance and by proposing principles for recalibrating assessment. We advocate for a balanced, programmatic assessment approach to ensure the holistic development of future family physicians.