Using Implementation Science to Explore the Integration of Entrustable Professional Activities in Swiss Cardiology Residency Training: A Qualitative Study.

BACKGROUND

Implementing entrustable professional activities (EPAs) necessitates faculty development, assessment standardization, and feasibility within established curricula. However, guidance for stakeholders involved in the implementation of EPAs in residency training is still limited.

OBJECTIVE

This study aims to support EPA implementation by exploring the experiences of lead implementers from different training sites. The research question is: Using an implementation science approach, what are the barriers and facilitators to the successful implementation of EPAs in residency training?

METHODS

Adopting a theory-informed design, we conducted a qualitative interview study using frameworks from implementation science to inform the interview guide and data analysis following the framework method. In 2024, we interviewed one lead individual responsible for EPA implementation at each of the 5 cardiology pilot training sites in Switzerland, thus covering all sites in the national pilot project. We used the framework method to systematically analyze the data, combining deductive and inductive steps.

RESULTS

We identified 4 dominant cross-site themes centered on feasibility, roles, acceptability, and adoption, with "resistance to change" emerging as a prominent inductive finding. Additional Consolidated Framework for Implementation Research (CFIR)-aligned subthemes illustrated contextual determinants across sites.

CONCLUSIONS

Accessible guidance, workflow alignment, and dedicated facilitators support the successful integration of EPAs and thus, competency-based medical education, while resistance to change and sustainability planning remain key challenges.