Entrusting Excellence: How Internal Medicine Clerkship Directors are Leveraging Entrustable Professional Activities
by Sherine Salib, M.D., MRCP; Saurin Gandhi, D.O. | February 2, 2026
Article Citation: Gielissen KA, Foust A, Weinstein AR, Duca N, Jenkins MO, Kisielewski M, Misra S, Dunne D. How Internal Medicine Clerkship Directors Are Using Entrustable Professional Activities: A National Survey Study. J Gen Intern Med 2025; 40(1):46-53. doi: 10.1007/s11606-024-08991-5.
What is this article about?
Entrustable Professional Activities (EPAs) are workplace-based assessments introduced to improve medical graduates’ readiness for residency. Their adoption and implementation in U.S. internal medicine (IM) clerkships have been variable, with limited evidence on their impact and validity.
A cross-sectional, nationally representative survey was conducted among 140 IM clerkship directors at Liaison Committee on Medical Education-accredited U.S. medical schools. The survey assessed EPA usage, grading practices, assessment frameworks, and validity efforts. The survey found that 47% use EPAs, with newer schools (post-1977 accreditation) more likely to adopt them. The AAMC Core EPAs for Entering Residency (CEPAER) was the most common framework (55%). EPAs are used for both formative and summative assessments, and about half of directors include them in final grades. Barriers include limited evaluator understanding, time constraints, and insufficient faculty development. Benefits cited were improved clarity, granularity, and feedback, but concerns about administrative burden and reliability remain.
Why should you read the article?
EPA adoption in IM clerkships is substantial and growing, but the use of EPAs in the undergraduate medical education (UME) setting is highly variable. Institutional support and infrastructure are critical for successful implementation. More research is needed to demonstrate outcomes related to student readiness for residency. It’s important for medical educators in UME to read this article because it highlights current EPA adoption, assessment practices, and barriers—offering actionable insights to improve student readiness for residency and guide evidence-based curriculum development.
How can you use this article?
UME educational leaders can use this article to benchmark EPA adoption, guide implementation strategies at their specific institutions, and anticipate barriers such as faculty development and administrative support. The findings offer practical insights for improving assessment quality, aligning with national trends, and ensuring students’ readiness for residency through robust, standardized, and meaningful evaluation systems.
Review Authors: Sherine Salib, M.D., MRCP; Associate Dean for Curriculum and Professor of Internal Medicine (Co-authored with Saurin Gandhi, D.O.), Dell Medical School at the University of Texas at Austin, Austin, TX. Organization: Clerkship Directors in Internal Medicine