Entrustable Professional Activities for Small-Group Facilitation: A Validation Study Using Modified Delphi Technique

M.Z. Iqbal*, K.D. Konings, M.M. Al-Eraky, J.J.G. van Merrienboer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Construct:Entrustable professional activities (EPAs) provide a novel approach to support teachers' structured professionalization and to assess improvement in teaching competence thereafter. Despite their novelty, it is important to assess EPAs as a construct to ensure that they accurately reflect the work of the targeted profession.Background:The co-creation of an EPA framework for training and entrustment of small-group facilitators has been discussed in the literature. Although a rigorous design process was used to develop the framework, its content validity has not been established yet.Approach: A modified Delphi technique was used. Three survey rounds were conducted from December 2019 to April 2020. Expert health professions educationalists were recruited using purposive sampling and snowball techniques. In Round 1, a rubric consisting of seven items was used to assess the quality of nine pre-designed EPAs. In Round 2, competencies required to perform the agreed-upon EPAs were selected from 12 competencies provided. In Round 3, consensus was sought on sub-activities recommended for agreed-upon EPAs. Quantitative data were analyzed using multiple statistical analyses, including item-wise and rubric-wise content validity indices, asymmetric confidence interval, mean, standard deviation, and response frequencies. Qualitative data were thematically analyzed using content analysis.Findings:Three of the nine proposed EPAs achieved statistical consensus for retention. These EPAs were: (1) preparing an activity, (2) facilitating a small-group session, and (3) reflecting upon self and the session. Nine of the 12 pre-determined competencies achieved consensus and were then mapped against each agreed-upon EPA based on their relevance. Finally, results indicated consensus on five, six, and four sub-activities for EPA 1, EPA 2, and EPA 3, respectively.Conclusions:The final framework delineates three EPAs for small-group facilitation and their associated sub-activities. The full description of each EPA provided in this article includes the title, context, task specification, required competencies, and entrustment resources. Program developers, administrative bodies, and teaching staff may find this EPA framework useful to structure faculty development, to entrust teachers, and to support personal development.
Original languageEnglish
Pages (from-to)536-545
Number of pages10
JournalTeaching and Learning in Medicine
Issue number5
Early online date15 Feb 2021
Publication statusPublished - 20 Oct 2021


  • entrustable professional activities
  • faculty development
  • teaching competence
  • teacher evaluation
  • small-group teaching


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