#3 Should HPE training for PhDs be EPA-based?

Host: Linda Snell

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Episode Article:

Gandomkar, R., Zaeri, R., & ten Cate, O. (2022). Expectations for PhDs in health professions education: An international EPA-framed, modified Delphi study. Advances in Health Sciences Education, 27(5), 1443–1456. https://doi.org/10.1007/s10459-022-10136-4


Health professions education (HPE) is becoming increasingly professionalized, and as such, advanced degrees have been expanding, and those working in HPE, either in HPE research units or to support other areas of Med Ed (e.g., curriculum development, assessment…) are being required to have an advanced degree in MedEd.  

Many current holders of PhDs working in HPE come from other fields and bring different perspectives. 

Doctoral programs in HPE vary from doing original research (developing ‘new knowledge’) and completing a dissertation in a specific area, to being exposed to a variety of research methods, theories, curriculum development strategies, and policies. 

As competency-based education (CBE) comes to the fore in medical education, the authors propose that an entrustable professional activity or EPA-like framework such as used in Med Ed could be used to identify or guide areas of competency for PhD students or graduates. In CBE one ‘starts with the end in mind’, in this case by asking ‘what will the holder of a PhD do?’ then designing the learning around these expectations using EPAs. An EPA is a task of a professional that can be entrusted to an individual once they have demonstrated the required competencies to carry the activity out unsupervised. While developed for medical professionals, the authors state that “this concept was deemed suitable to conceptualize the work field of PhDs in health professions education”, although they don’t give any rationale for this statement. 

In one country (Iran) one consensus study clarified HPE PhD expectations, producing 34 EPAs in the areas of educational development, research and scholarship, and educational management. 


Using the Iranian EPAs as a starting point, this study sought more generalized validity and a wider consensus of suitable activities for PhDs in HPE.  

While the purpose of the study was not to determine what activities should necessarily be incorporated in HPE-PhD training programs, the results could inform such programs, learners, and future employers’ work expectations. 


Participants a convenience sample, targeted members of the Society of Directors of Research in Medical Education (SDRME), and in addition international experts using purposive sampling of authors’ networks. Unclear if all were holders of PhDs or if any worked in other (non HPE research) education units who employ PhDs.  148 approached, 18 started Delphi, 15 finished 3 rounds. Half from USA, rest from other western countries. 

A 3-round Delphi over 8 months. Used the 34 Iranian EPAs. 

Round 1: for each EPA 10 questions (5 Likert scale and 5 open-ended). 240 items, questions re relevance of the EPA for HPE PhD graduates, clarity of the title, comprehensiveness of the specifications and the potential risks in case of failure in the EPA, and appropriateness of the limitations. 

Round 2: revised titles and comments, merged some, and removed any with a low content validity index for a total of 17 EPAs. Added questions for each EPA: (1) I believe that currently most PhDs in HPE can be trusted to do this without supervision, (2) It is desirable that most PhDs in HPE can be trusted to do this without supervision, and (3) Should this EPA be included in HPE-PhD training?  Total 162 items 

Round 3: removed one EPA for total of 16, overall question per EPA on adequacy of the EPA description. Total 45 items 

Described a ‘content validity’ score 


“Identified 17 EPAs that belong to the expectations of educators with a PhD degree in HPE. Of the 17, 8 relate to the domain of research and scholarship, and 9 pertain to educational development.” 

All managerial EPAs removed or incorporated into Ed Development. 

6/17 considered ‘core’ for training and expectations (1,5,6,7,8,15)  

Only ‘presenting at meetings’ found high agreement that most current HPE PhDs can be trusted to do this unsupervised.  

12 EPAs a minority of the respondents agreed that current HPE PhDs can be trusted to do these unsupervised. Suggests panel members had expectations for HPE PhDs that exceed the current reality for many HPE PhDs.  

(Table from Gandomkar et.al., 2022)


EPAs have been proposed for other domains, e.g., teaching; the authors add to this expansion from clinical medicine, giving a looser use of the definition. Authors did not apply formal methods to evaluate the validity of the EPA descriptions. They do “acknowledge for example that ’supervision’ of work reflected in these EPAs is different than in patient care, [and] in defining EPAs for PhDs in HPE they have about stretched the applicability of the concept”. 

The question is … can the concept of entrustment truly be applied to tasks of PhD in HPE? 

“PhDs may be regarded as individuals who have matured through a process of learning, working and discovering that may make them ready to be tasked with obligations they have not encountered before but that they can tackle mostly because of their experience with scientific thinking, general acquaintance with the HPE literature, experience with some research approaches, but tangentially familiar with other research methods. Even in domains not deeply touched upon in PhD training, graduates may be trusted to develop the capability to do that scholarly work.” 

Articles around Delphi method

Humphrey-Murto, S., Varpio, L., Gonsalves, C., & Wood, T. J. (2017). Using consensus group methods such as Delphi and Nominal Group in medical education research. Medical Teacher, 39(1), 14–19. https://doi.org/10.1080/0142159X.2017.1245856

Humphrey-Murto, S., Wood, T. J., Gonsalves, C., Mascioli, K., & Varpio, L. (2020). The Delphi Method. Academic Medicine, 95(1), 168. https://doi.org/10.1097/ACM.0000000000002887

Want to read up on Entrustable Professional Activities (EPA)?

Ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176–1177. https://doi.org/10.1111/j.1365-2929.2005.02341.x

Ten Cate, O., & Taylor, D. R. (2021). The recommended description of an entrustable professional activity: AMEE Guide No. 140. Medical Teacher, 43(10), 1106–1114. https://doi.org/10.1080/0142159X.2020.1838465


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