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Background: Entrustable Professional Activities (EPAs) are increasingly used in undergraduate medical education to structure curricula. A key aspect of their implementation is ensuring that the defined EPAs align with actual workplace expectations. This study investigates the extent to which specified core EPAs and medical procedures are used for formative assessment in a final-year clerkship in an undergraduate medical curriculum.

Summary of work: In May 2023, an EPA-based electronic-(e)portfolio system was implemented in the final clerkship year at Charité – Universitätsmedizin Berlin, Germany. This system is utilized by final-year students during rotations in internal medicine, surgery, and anesthesiology. Over 16 weeks, students are required to complete and document at least 15 workplace-based formative assessments. They can select 10 core EPAs and 11 general procedures in all three disciplines. An additional 10 specialty-specific procedures can be selected in surgery and 25 in anesthesiology. The analyses focused on how often the EPAs and procedures were used for formative assessment purposes in the respective specialties.

Summary of results: Between May 2023 and November 2024, a total of 19,125 assessments were completed and documented in the e-portfolio system:

723 internal medicine students completed 8,901 assessments, with 53% core EPAs and 47% general procedures.

688 surgery students completed 8,036 assessments, with 33% vore EPAs, 47% general procedures and 37% specialty-specific procedures.

177 anesthesiology students completed 2,188 assessments, with 17% core EPAs, 25% general procedures and 58% specialty-specific procedures.

All defined core EPAs, general procedures, and specialty-specific procedures were utilized for formative assessment, albeit with varying frequency.

Discussion and conclusion: The e-portfolio system offers students a broad selection of EPAs for assessment, meaning not all EPAs are completed by every student. However, findings confirm that all defined core EPAs and medical procedures were used for formative assessment and feedback. Core EPAs and general procedures, applicable across multiple specialties, proved valuable. However, in disciplines with a high number of specialty-specific procedures, students primarily engaged with those procedures.

Take home message: To address real workplace expectations, it is necessary to define and include specialty-specific procedures alongside core EPAs and general procedures.