Status of Entrustable Professional Activities (EPA) Implementation at Colleges of Osteopathic Medicine in the United States and Future Considerations

Context: Competency-based medical education, developmental milestones for residency training, and the single graduate medical education (GME) accreditation system have emerged over the last decade, necessitating new ways to adequately prepare graduates to meet new standards in proficiency, including the 13 Core Entrustable Professional Activities (EPA) for Entering Residency. The American Association of Colleges of Osteopathic Medicine (AACOM) Entnistable Professional Activities (EPA) steering committee has implemented an information-gathering process to provide suggestions for supporting a variety of EPA-related implementation efforts at colleges of osteopathic medicine (COMs) across the country. Objective: To review the status of EPA implementation at COMs nationally. Methods: An explanatory mixed-methods design was used to guide information gathering and synthesis of a 41-question survey and interview feedback; the overarching premise of this design was to use qualitative data to build upon initial quantitative findings. This survey was delivered electronically through a link emailed to liaisons at each main, branch, and satellite campus of the 47 schools within the AACOM institutional database. After survey administration, follow-up structured interviews were conducted according to an 18-question script with a purposive sample of 16 institutions with EPA implementation levels ranging from "moderate implementation with reporting" to "full implementation with reporting." Post-interview, the interview notes were analyzed and results were aggregated for comparison with the original survey findings. Results: Of the 47 schools surveyed, 42 responded (89.4%). To maintain uniformity in data coding and analysis, 36 of 47 (76.6%) of COMs with independently submitted survey responses were retained in the review. The majority of those respondents (23 of 36; 64%) indicated that their institution was above "somewhat knowledgeable" toward "expert" regarding knowledge of EPAs, but 23 (64%) also indicated "no confidence" or "somewhat confident" regarding EPA implementation. Postinterview results showed that the majority of schools were equally distributed across the "foundational implementation" (10; 28%), "slight implementation" (11; 31%), and "moderate implementation" (11, 31%) categories, with a few schools indicating "no implementation" (2; 5%) or "progressive implementation" (2; 5%). Conclusion: The results of this review indicate that most osteopathic medical schools are at the early stages of EPA implementation, with emphasis varying by program year in terms of the specific EPAs addressed. Many schools appear engaged in curricular change efforts that will support the advancement of EPA use within their institutions. Faculty development was identified as a continued critical need for a majority of institutions.