Development and validation of an instrument to assess the readiness of entrustable professional activity implementation in undergraduate medical education in Indonesia

Abstract

Entrustable Professional Activities (EPAs) bridge competency-based education and workplace activities. Limited evidence exists for EPA implementation in Indonesian undergraduate medical education. This study aimed to develop and validate an instrument assessing EPA implementation readiness in Indonesian undergraduate medical programs. A sequential exploratory mixed-method design was employed across three stages. The qualitative research stage involved interviews with Asian and Indonesian medical education experts, heads of medical education units, and medical teachers. In the second stage, the instrument was developed and validated through content, face, and construct validation. Stage three comprised a quantitative study at Universitas Muhammadiyah Jakarta (UMJ). Results found the needs for each dimension of EPA implementation (EPA development, EPA application, entrustment decision, and management initiatives for change). EPA development necessitates conceptualization and standardization, the development team, and stakeholder involvement. The EPA application requires the readiness of teachers, medical students, curriculum, and supportive systems. Entrustment decisions need a systematic entrustment assessment and the assessors for entrustment decisions. Management initiatives for change require leaders’ commitment, strategic planning for change, resource management, faculty development, stakeholder engagement and support, and quality assurance. Thus, the questionnaire was developed based on the teachers’ roles in each dimension. The content validation with seven experts resulted in an s-CVI of 0.94-0.96. After the construct validation, the questionnaire contained 72 items covering Knowledge, Attitude, and Practice (KAP) domains of teacher readiness, plus management preparedness perception domains. Teachers’ readiness is represented by ten factors of KAP domains. Management initiatives' preparedness for change consisted of three factors associated with perceptions of students-curriculum-support systems, and two factors related to change management preparedness. The UMJ readiness preliminary study revealed teacher readiness varied across roles: curriculum planner (35.7% high readiness), learning facilitator (27.1%), assessor (28.6%), and change agent (14.3% high readiness). Management initiative preparedness showed balanced distribution (27.1% high, 22.9% moderate, 24.3% developing, 25.7% limited), indicating heterogeneous institutional capacity. This pioneering study provides a validated questionnaire for assessing EPA implementation readiness in Indonesian undergraduate medical education programs.