Entrustable Professional Activities and Physician Assistant Student Motivation

With the movement of medical education toward competency-based models, more needs to be understood about how to best assess and ensure student competence. As entrustable professional activities (EPAs) have become a recommended method for student assessment, more needs to be known about both the psychometric strengths and weaknesses of the model, but also how assessment using concepts of trust impact the learner in learning environments. The impact of EPA-based assessment on levels of self determination and intrinsic motivation is of particular value. The important educational construct of motivation can help to define the value of the use of EPA-based models. To answer this study’s research questions, a qualitative research design was utilized to explore the experience of feedback and assessment based on trust and its effect on levels of self-determination, a well-documented and supported marker of motivation. Utilizing a standardized simulation activity, PA students were evaluated and provided feedback using an assessment model based on an EPA-based framework. Following this, qualitative data collection including interviews and reflection journals were completed to better understand the learner experience of EPA-based assessment and its implications for self-determination and learner motivation. The current study found entrustment allowed for a clear understanding of clinical performance. Quality entrustment feedback supported participants’ sense of competence and increased their beliefs that they could be trusted to be autonomous and a valuable part of the team. This appeared to be a unique aspect of the entrustment process—the ability to not only bolster learner sense of competence, but also to use entrustment as abridge to support autonomy and relatedness to others. To the extent the interpersonal power of trust was able to support a learner’s sense of competence, other SDT propositions could be subsequently bolstered as well. As a result, self-determination and intrinsic motivation can be uniquely supported with EPA-based assessment. Further research is needed to better understand possible negative affective and motivational impacts of EPAs