From professional tasks to contexts: A consensus study on chief complaints as clinical anchors for EPAs for entry into residency.

PURPOSE: Entrustable professional activities (EPAs) for entry into residency often remain broad and underspecified and lack alignment with the clinical contexts that medical graduates encounter. This study aims to identify chief complaints that can serve as context anchors for EPAs for entry into residency.

METHODS

A structured, expert consensus survey was conducted in 2024 at Charité-Universitätsmedizin Berlin, Germany. In total, 192 participants from four groups (senior medical students, hospital residents, hospital specialists, and general practitioners) rated 134 chief complaints. An 80% threshold was set to define a consensus on the relevance of complaints for autonomous differential diagnostic work-up by new residents under supervision level 3b.

RESULTS

Forty-four chief complaints (33%) reached the consensus threshold, with abdominal pain, dyspnoea, fever and cough receiving the highest agreement (>97%). Strong consistency was observed across expert groups, with all four groups agreeing on 35 complaints. For the remaining nine, only minor variations were observed, with generally only one expert group falling below the 80% threshold.

CONCLUSIONS

Defining core chief complaints offers a practical approach to contextualize undergraduate EPAs, thereby bridging the gap between educational expectations and real-world clinical practice. These findings support curriculum alignment and entrustment decisions while promoting trainees' readiness for early postgraduate training.