A Four Dimensions and Its Implementation Needs for Entrustable Professional Activities in Undergraduate: Scoping Review

Introduction: Implementing Entrustable Professional Activities (EPAs) in the undergraduate setting requires guidance. This review aimed to identify evidence about the essential dimensions and needs for implementing EPAs. Method: This review followed Joanna Briggs Institute guidance and PRISMA-ScR standards. English articles (2020-2023) on EPA implementation in undergraduate medical programs were searched from WoS, Scopus and EBSCO. Four independent reviewers screened records using Rayyan.ai, excluding reviews, postgraduate programs and non-medical professions. Three reviewers independently extracted and coded data using NVivo, with all disagreements resolved through discussion. Result: There were 790 unique records and 19 studies were extracted. Four essential dimensions for EPA implementation, namely EPA development (n = 9), EPA application (n = 13), entrustment (n = 10) and change management (n = 13), were identified. From this review, it was found that EPA development needs conceptualization, determining the development method and aligning with the curriculum. Whilst the needs for EPA application were students' and teachers’ factors, feedback provision, curriculum characteristics, etc. Entrustment decision entails raters’ cognition, a competencies committee and an awarding process. Change management needs leadership, commitment, a task force, resources, etc. Conclusion: This review establishes a comprehensive framework of four essential dimensions and their specific requirements for EPA implementation in undergraduate medical education. These evidence-based findings serve as foundational guidance for institutions planning EPA implementation and provide a basis for developing assessment tools to evaluate institutional readiness.