Background: Recently, all medical universities in Sweden jointly developed a framework for Entrustable Professional Activities (EPAs) for work-based training and assessment. This framework is now being introduced nationally in thenew 6-year undergraduate medical programme that directly lead to a licence to practise. When EPAs are introduced,it is of central importance to gain clinical supervisors’ acceptance to apply the framework in their supervision ofstudents. The aim of this study was therefore to investigate how clinical supervisors, not familiar with EPAs, experienceclinical supervision using the framework for EPAs.

Methods: We used a purposive sampling to recruit clinical supervisors. They were given written information on EPAswith a selection of suitable EPAs and the Swedish observation rating scale for assessment of autonomy, and theywere offered to attend a 30-minute introductory web course. The participants were informed that EPAs were to betested, and the students were asked to participate. After the study period the clinical supervisors participated in semistructured interviews. Inductive qualitative content analysis was used to analyse the transcribed interviews.

Results: Three general themes emerged in the qualitative analysis: Promoting Feedback, Trusting Assessmentsand Engaging Stakeholders. The participants described benefits from using EPAs, but pointed out a need forpreparation and adaptation to facilitate implementation. The structure was perceived to provide structured supportfor feedback, student involvement, entrustment decisions, enabling supervisors to allow the students to do morethings independently, although some expressed caution to rely on others’ assessments. Another concern waswhether assessments of EPAs would be perceived as a form of examination, steeling focus from formative feedback.To understand the concept of EPA, the short web-based course and written information was regarded as sufficient.However, concern was expressed whether EPA could be applied by all clinical supervisors. Involvement and adaptionof the workplace was pointed out as important since more frequent observation and feedback, with documentationrequirements, increase the time required for supervision. 

Conclusions EPAs were accepted as beneficial, promoting structured feedback and assessments of the students’autonomy. Preparation of supervisors and students as well as involvement and adaptation of the workplace waspointed out as important.