The EPA Project aims to implement and strengthen competency-based postgraduate training in Family Medicine across South Africa, using a national set of EPAs and a shared electronic Portfolio of Learning (ePoL) system (SCORION). The initiative supports transformation, standardisation, and quality assurance of clinical training and assessment.

About the Project

The current system of assessment in South Africa relies on assessments such as multiple choice questions (MCQs) and Objective Structured Clinical Examination (OSCE). MCQs focus on knowledge and the application of knowledge. OSCEs are artificial situations that simulate a clinical environment. While these assessment tools have some merit, OSCE stations cannot sample an adequate number of the procedural skills required and may neglect many competencies due to the competencies being too complex and impractical to include. Based on these concerns, South Africa’s medical education needs to produce healthcare professionals equipped to cater to the needs of the South African population. This underscores the necessity of transitioning from the current curriculum to a competency-based approach. This shift allows healthcare professionals to change South African healthcare positively. Hence, the introduction of EPAs can advance competency-based medical education to achieve greater quality assurance for medical graduates.

This study aims to understand how EPAs are implemented as a credible process to improve postgraduate family medicine training in South Africa. The study objectives are

– To explore factors that have facilitated or hindered the implementation of EPAs in postgraduate family medicine training in South Africa.

– To explore the understanding of consultants and registrars about key constructs of EPAs (competency, milestones, entrustment, supervision, feedback, programmatic assessment)

– To evaluate the rollout of EPAs among all nine family medicine programmes in South Africa

– To make recommendations on improving the design and implementation of EPAs in the SA context.

Study Sites

The programme has been implemented across nine institutions in South Africa, namely Walter Sisulu University (WSU), University of KwaZulu-Natal (UKZN), University of Cape Town (UCT), Stellenbosch University, University of Free State (UFS), University of Witwatersrand (Wits), University of Pretoria (UP), Sefako Makgatho Health Sciences University (SMU), and University of Limpopo (UL). All nine medical schools train registrars in FM and have all adopted the EPA-based curriculum.

Outcomes

Short-Term Outcomes:

• Improved alignment between EPAs and learning objectives.
• Increased use of ePoL for tracking performance.

Intermediate Outcomes:

• Enhanced trainee competence in core professional activities.
• Increased consistency in assessment practices across schools.

Long-Term Outcomes:

• Graduates demonstrate readiness for independent practice.
• Broader acceptance of EPAs as a national standard in Family Medicine education.

Research Team

Professor Mergan Naidoo

Dr Kimera Tamzin Suthiram