Implementation of Core Entrustable Professional Activities in the Internal Medicine Clerkship: A Psychometric Study

BACKGROUND: Entrustable professional activities (EPAs) have been proposed as a holistic approach to competency-based assessment. The 13 Core EPAs for Entering Residency (CEPAER) are essential tasks that a medical student should be trusted to perform with indirect supervision upon entering residency, based on demonstrated competence. OBJECTIVE: To study the validity and reliability of workplace-based assessments of the 13 core EPAs as measurements of medical student performance and growth over the Internal Medicine (IM) clerkship. DESIGN: Correlational-based population study. PARTICIPANTS: A total of 398 third-year medical students at the University of Minnesota Medical School participated. Students were enrolled in a required 8-week IM clerkship during the 2023-2024 and 2024-2025 academic years. A total of 825 assessors provided EPA ratings with a mean number of 12 per assessor; SD = 15.08. MAIN MEASURES: There were 10,034 EPA-based assessments collected (mean per student = 25; SD = 6.1). The most frequently assessed EPAs were EPA 6 (Provide an oral presentation of a clinical encounter; n = 1866; mean per student = 4.69), EPA 5 (Document a clinical encounter in the patient record; n = 1662; mean per student = 4.18), and EPA 2 (Recommend and interpret common diagnostic and screening tests; n = 1421; mean per student = 3.57). KEY RESULTS: Regression analyses indicated statistically significant growth in entrustment scores for EPAs 1, 2, 3, 5, 6, 8, 10, and 12. Generalizability analysis showed that to achieve adequate reliability (Ep2 ≥ 0.80), at least 5 assessments were required to be conducted by 5 raters. CONCLUSION: EPAs represent a valid and reliable measure for medical student growth during the IM clerkship, particularly for EPAs 1, 2, 3, 5, 6, 8, and 10.