For which entrustable professional activities must medical students be prepared if unsupervised patient care without further training is an expectation?: An international Global South study

Abstract

INTRODUCTION: Training medical students requires objectives that are often translated into frameworks of competencies. Since the introduction of entrustable professional activities (EPAs), these tasks or 'units of professional practice', originally conceived for postgraduate training, define what residents must be prepared to do unsupervised. Nowadays, EPAs are also applied to undergraduate training, with the prospect of entering residency. However, in many countries, especially in the Global South, a substantial number of medical graduates will be working in healthcare with little or no supervision and no further training soon or ever. EPAs for these conditions cannot be copied from undergraduate medical education EPA frameworks in Global North countries. METHODS: We conducted a generative investigation to identify and elaborate EPAs for Global South countries who must train students for unsupervised general practice. We included 39 medical educators from 13 Global South countries and 17 specialties in either one of two online focus group sessions using a nominal group technique (NGT) or as Delphi panel member. Results from the two NGT sessions were merged and fed into the two-round Delphi investigation. RESULTS: A framework of 11 EPAs resulted, each with an elaborate description (specification, setting and limitations). CONCLUSION: This framework of undergraduate medical education Global South EPAs differs in its nature and specifications from existing Global North EPAs. The authors do not pretend universality for all Global South countries with graduates who face expectations of unsupervised practice but present it to support countries that consider introducing the model of entrustable professional activities.