Evaluating the implementation of EPAs in undergraduate medical education with the RIME model

Abstract Background: Undergraduate Entrustable Professional Activities (EPAs) are intended to entrust future physicians with a number of clinical tasks from their first day of residency, in accordance with the competency-based medical education (CBME) reform. While the development and implementation of EPAs has been widely published in postgraduate, little is known about the actual use of undergraduate EPAs and whether their evaluation follows a progression in terms of complexity and autonomy over the course of the clerkship. Methods: This is a descriptive study of undergraduate EPAs reported during the first clerkship year of the University of Geneva medical school. The EPAs are grouped according to the related RIME roles (Reporter, Interpreter, Manager and Educator) to assess the number of occurrences and conditions of supervision of clinical tasks. Results: Two cohorts recorded 42642 EPAs over the two years after the CBME implementation. 55.2% of the EPAs were related to the Reporter role, 22.1% to the Interpreter role, 19.1% to the Manager role, and 3.6% to the Educator role. The EPAs are mainly evaluated as observer or under direct supervision. Neither the number of EPAs related to higher RIME roles, nor the percentage of indirect supervision increased over the 12 months of clerkship. Conclusions: During their first year of clerkship at the University of Geneva school of medicine, students do not seem to increase their exposure to EPAs related to higher RIME roles, nor to gain in autonomy regarding the clinical tasks they carry out. This might be due to insufficient entrustment conditions, highlighting the importance of reflection on clerkship conditions to align with CBME.