Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

Abstract

Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.