The concept of Entrustable Professional Activities (EPAs) has been introduced in postgraduate medical
education to try to bridge the gap between theoretical aspects of competency-based education and
real-life clinical care (ten Cate et al., 2010). EPAs have been described as tasks or responsibilities to be
entrusted to the unsupervised execution by a trainee once they have attained sufficient specific
competence (ten Cate, 2013). Progress towards this is described on a scale based on level of
entrustment.
This thesis aims to explore the use of EPAs for final year medical undergraduates. Using Kane’s
framework, I present a validity argument for the use of EPAs in this context using mixed methods
underpinned by the ontological framework of Critical Realism and an interpretivist epistemology. I
conclude that EPAs may be used in the assessment of the undergraduate - but the context in which
we use them is fundamental to their validity. And the way in which we interpret, and ultimately use,
these results require further exploration.
I then go on to consider the process of entrustment from the perspective of the clinical learner by
performing a literature review and identify a lack of published research on this in medical education.
I therefore employ a hermeneutic methodology to allow inferences to be drawn from other relevant
domains. Ultimately, I propose a model for how the perception of clinical trust may impact the clinical
learner and their self-efficacy. To address the paucity of literature to be found in the medical
education domain, I subsequently present novel research on the impact of entrustment from the
perspective of the clinical learner. An interview study was carried out with four newly qualified junior
doctors to investigate their individual experiences of trust and mistrust using interpretative
phenomenological analysis. This work demonstrates the reality of entrustment for these people in
their context and the superordinate themes reveal important points which may be transferable to
other learners including the importance of the use of explicit expressions of entrustment – such as
those to be found in the EPA scale
