Evaluation of 6th year medical students' approach to critical patient management in complex emergency situations with entrustable professional activities

Objective: This study aims to evaluate 6th year medical students approaches to critical patient management in complex emergency situations within the framework of Entrustable Professional Activities (EPA's), to examine whether they have the necessary competencies and attitudes to fulfil this task and to identify areas for improvement in training. Method: This mixed methods study evaluated the management of critical patients in complex emergencies by twenty-one 6th year medical students using the EPA framework. Three EPA-10 based scenarios, developed with emergency medicine and medical education experts, simulated real-life critical care challenges. 6th year medical students' performance was observed and assessed across eight domains: communication, history-taking, physical examination, clinical decision-making, leadership, clinical knowledge, procedural skills, and resuscitation. 6th year medical students also completed self-reflection surveys on their perceived competence and performance. Qualitative data were utilized to understand the quantitative findings in depth. Results: High inter-rater reliability (Fleiss' Kappa = 0.77) validated the scoring. In analyses with repeated measures ANOVA, the three-way interaction between cases, competence and assessor type was also significant (F(7.544, 301.761) = 13.085, p < 0.001, η² = 0.246). Strengths such as story taking and communication were revealed in the trainer evaluations. Discrepancies between students' evaluations and observed performance (particularly in procedural skills and leadership) highlighted the need for developing self-regulation skills. Conclusion: EPA-focused assessments, with feedback, can enhance 6th year medical students understanding of their performance and guide professional development. The developed scenarios and assessment lists can inform students about their performance and address learning deficiencies. Key words: Entrustable Professional Activities, Competencies, Assessment and Evaluation, Simulation, Medical Education