Evaluation of the use of Entrustable Professional Activities as a novel assessment framework with competency assessment tools in undergraduate physiotherapy clinical practice education in Singapore.

<p dir="ltr">Background Despite its growing use in other healthcare professions education, little is known about implementing Entrustable Professional Activities (EPAs) in undergraduate physiotherapy curricula1. Using the OTTAWA Consensus framework for good assessments2, the use of EPAs was evaluated with the extant Competency and Clinical Reasoning Assessment (CCRA) as a system of assessments in Singapore's undergraduate physiotherapy clinical practice education (CPE). </p><p dir="ltr">Methods A deductive qualitative study evaluated the second cycle of EPA implementation. Focus group discussions (FGDs) used semi-structured interviews, guided by the seven OTTAWA criteria of good system of assessments and by the first EPA implementation cycle survey responses3. Three final-year physiotherapy student groups and four clinical educators (CEs) groups from various clinical domains and practice settings were held (total 16 students and 16 CEs). Thematic analysis was performed. </p><p dir="ltr">Results Seven themes emerged: (1) good understanding of entrustment as readiness for practice with indirect supervision (Purpose-driven); (2) indirect supervision appropriate end entrustment level for students' training (Acceptable); (3) CEs' ambivalence accepting entrustment level as readiness for practice (Acceptable, Continuous); (4) acknowledgement of complementarity of EPAs with the CCRA but perception of overlap and additional work render EPA assessment unwarranted (Coherence, Feasible); (5) variation and subjectivity of CEs' decision to reduce supervision (Transparent and free from bias); (6) variations in the use and execution of the tool (Transparent and free from bias); (7) revised form is practical for CEs (Feasible). </p><p dir="ltr">Conclusion The use of EPAs in this context was found to be purpose-driven and feasible. EPAs and CCRA were somewhat coherent for the purposes of CPE assessments. Students and CEs preferred EPAs as learning tools. More work is needed to improve the use of EPAs as an assessment by improving acceptability and stakeholders' understanding of the use and execution of the tool, including clearer points-of-prompts for CEs to reduce supervision.</p>