Implementation challenges and regional practices of entrustable professional activities in a global context

doi:10.3760/cma.j.cn115259-20260201-00156

Chinese Journal of Medical Education ›› 2026, Vol. 46 ›› Issue (5): 321-325.DOI: 10.3760/cma.j.cn115259-20260201-00156

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Implementation challenges and regional practices of entrustable professional activities in a global context

Li Shan¹, Qi Jianguang¹, He Rui², Qi Xin², Olle ten Cate³

¹Children′s Medical Center, Peking University First Hospital, Beijing 102627, China;
²Department of Plastic Surgery & Burns, Peking University First Hospital, Beijing 100034, China;
³School of Medicine, University Medical Center Utrecht, Utrecht 1003584, Netherlands

Received:2026-02-01 Online:2026-05-01 Published:2026-04-30
Contact: QiXin,Email:randyq@126.com
Supported by:
The Project of China Medical Board (22-457); The Educational Teaching Research Project in Peking University Health Science Center (2022YB34); Clinical Medicine Plus X-Young Scholars Project, Peking University, the Fundamental Research Funds for the Central Universities (2024-31); Special Project for Demonstration Smart Course Construction under the Education Teaching Reform and Research Program, Peking University Health Science Center (2025SFZD10)

Abstract

Abstract: Entrustable professional activities (EPAs) have become a critical bridge connecting ″competency″ with ″actual clinical practice″ in medical education. However, various challenges arise during their implementation at the micro, meso, and macro levels. On August 24, 2025, an international symposium titled ″Entrustable Professional Activities: Issues in Global Implementation″ was organized in Barcelona by Olle ten Cate and Marije P. Hennus from the University Medical Center Utrecht in the Netherlands, along with Roberta I. Ladenheim from the University Institute of the Italian Hospital of Buenos Aires in Argentina. The symposium brought together medical education experts from around the world to engage in in-depth discussions on the challenges and strategies of implementing EPAs across different cultural, policy, and healthcare systems. This article systematically reviews the common challenges encountered in the implementation of EPAs and the practical experiences from various regions, aiming to inform and inspire medical educators.

Key words: Education, medical, Entrustable professional activities, Competency-based medical education, Global implementation, The International Association for Health Professions Education

CLC Number:

Li Shan, Qi Jianguang, He Rui, Qi Xin, Olle ten Cate. Implementation challenges and regional practices of entrustable professional activities in a global context[J]. Chinese Journal of Medical Education, 2026, 46(5): 321-325.

References

[1] Ten Cate O. Entrustability of professional activities and competency-based training[J].Med Educ, 2005,39(12):1176-1177. DOI:10.1111/j.1365-2929.2005.02341.x.
[2] The ins and outs of EPAs courses[EB/OL].[2026-02-01].https://amse-med.eu/courses/.
[3] Ten Cate O, Chen HC, Hoff RG, et al. Curriculum development for the workplace using Entrustable Professional Activities (EPAs):AMEE Guide No. 99[J].Med Teach, 2015,37(11):983-1002. DOI:10.3109/0142159X.2015.1060308.
[4] Schumacher DJ, Michelson C, Winn A, et al. Graduating residents′ readiness for unsupervised practice[J].Pediatrics, 2025,155(5):e2024070307.DOI:10.1542/peds.2024-070307.
[5] Carraccio C, Lentz A, Schumacher DJ. Dismantling fixed time, variable outcome education: abandoning ′ready or not, here they come′ is overdue[J].Perspect Med Educ, 2023,12(1):68-75. DOI:10.5334/pme.10.
[6] Ten Cate O, Carraccio C. Envisioning a true continuum of competency-based medical education, training, and practice[J].Acad Med, 2019,94(9):1283-1288. DOI:10.1097/ACM.0000000000002687.
[7] De Raad T, Wiersma F, Kuilman L, et al. The fate of entrustable professional activities after graduation: a survey study among graduated physician assistants[J].J Contin Educ Health Prof, 2023,43(1):28-33. DOI:10.1097/CEH.0000000000000467.
[8] Ten Cate O, Taylor DR. The recommended description of an entrustable professional activity: AMEE Guide No. 140[J].Med Teach, 2021,43(10):1106-1114. DOI:10.1080/0142159X.2020.1838465.
[9] Hennus MP, Jarrett JB, Taylor DR, et al. Twelve tips to develop entrustable professional activities[J].Med Teach, 2023,45(7):701-707. DOI:10.1080/0142159X.2023.2197137.
[10] 齐心,金哲,韩晓宁,等. 住院医师置信职业行为指标的构建研究[J].中华医学教育杂志,2021,41(2):104-108. DOI:10.3760/cma.j.cn115259-20201117-01599.
[11] Li S, Qi X, Li H, et al. Exploration of validity evidence for core residency entrustable professional activities in Chinese pediatric residency[J].Front Med (Lausanne), 2023,10:1301356. DOI:10.3389/fmed.2023.1301356.
[12] Hall AK, Oswald A, Frank JR, et al. Evaluating competence by design as a large system change initiative: readiness, fidelity, and outcomes[J].Perspect Med Educ,2024,13(1):95-107. DOI:10.5334/pme.962.

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Implementation challenges and regional practices of entrustable professional activities in a global context

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