Assessing Intern Confidence in Entrustable Professional Activities at Onset and Conclusion of First Year of Training: A Longitudinal Observational Study

ABSTRACT Background The Association of American Medical Colleges developed 13 core entrustable professional activities (EPAs) interns should proficiently perform with indirect supervision when starting residency. Despite efforts to integrate EPAs into undergraduate medical education, concerns persist regarding graduate preparedness, including interns’ self-confidence in performing EPAs. Understanding interns’ self-reported confidence can play a role in shaping early postgraduate supervision strategies and influence clinical decision-making as well as professional identity formation. Objective To assess the change in interns’ self-reported confidence in performing EPAs from the start to end of internship. Methods An observational study was conducted at a university-based academic midwestern internal medicine residency program from 2019 to 2024. All interns (167 of 167) completed a confidence survey during orientation, and 83% (138 of 167) completed the same survey at the end of internship. Matched paired t tests evaluated changes in confidence over time. Changes for individual EPAs were examined using effect size metrics. Results At the start of internship, EPAs with the highest percentage of self-reported confidence were history/physical examination (65%, 109 of 167), clinical encounter documentation (53%, 89 of 167), and team collaboration (72%, 121 of 167). Matched paired t tests showed increased confidence across all 13 EPAs over the year with a mean increase of 11.95 out of 65 possible points. Although confidence improved for all EPAs, 70% (97 of 138) of interns still lacked confidence performing general procedures and 59% (82 of 138) lacked confidence in identifying system failures. Conclusions Intern confidence significantly improved across all core EPAs over the year, though notable gaps remained in areas such as procedures and system failures.