Development of a Grid Based on Entrustable Professional Activities for the Assessment of Clinical Competencies of Final-Year Bachelor of Science in Nursing Students: A Participatory Approach

Abstract

Purpose: Clinical placements are an essential learning method for developing competencies in Bachelor of Science in Nursing (BScN) programs. However, assessing competencies in clinical settings remains challenging, particularly due to difficulties in interpreting them in real-world contexts. The entrustable professional activities (EPAs) approach was originally developed in medical residency programs to operationalize competency frameworks, which were considered too theoretical for education and assessment in clinical settings. Although this approach has been little explored in nursing, it appears promising. While some scholars have proposed EPA frameworks, none have used this approach to develop a tool for assessing competencies in clinical placements. This article presents the process of developing an EPA-based grid to assess the competencies of final-year BScN students during clinical practica.

Method: The approach undertaken involved the participation of individuals from both clinical and academic settings involved in clinical placement evaluation, as well as students. In line with the recommendations of Hennus et al. (2023), the process involves four general phases: 1) preparation; 2) development; 3) revision; and 4) implementation. It also incorporates the recommendations proposed by Taylor et al. (2021) to ensure that EPAs accurately reflect professional practice. The first three phases of the process are presented, as the implementation phase is currently ongoing.

Results: The grid developed includes three EPAs, further detailed into eight sub-EPAs, which are presented along a vertical axis in the first column on the left. Levels of supervision are displayed along the horizontal axis, progressing from left (“requires someone to perform this activity on their behalf”) to right (“no longer requires supervision to perform this activity”). Descriptors specify the criteria for each sub-EPA according to the level of supervision. The competencies mobilized for each EPA are also specified. The individuals consulted considered the EPA approach to be highly relevant and advantageous, particularly because it clarifies expectations. The EPAs were deemed to align with nursing practice in Quebec. The descriptors were viewed as clear and consistent with the various levels of supervision and expectations for final-year students. In commenting on the feasibility and usefulness of the grid, supervisors indicated that it was more intuitive and easier to complete, thereby facilitating guidance and feedback. Students reported that the grid provided clear direction for developing their competencies and autonomy.

Conclusion: The descriptive, criteria-based EPA grid proved to be relevant and useful for developing and assessing the clinical competencies of final-year BScN students. Given that the EPA approach is still rarely used in this context, this adaptation represents a potential avenue for advancement in nursing education and the discipline as a whole.