Developing and Validating Entrustable Professional Activities (EPAs) for Rheumatology Fellowship Training Programs in Saudi Arabia: A Delphi Study

Laila A Alharbi,1 Mohamed Cheikh,2 Manal E Alotaibi,1 Amal A Alkhotani,1 Hussam M Alim,1 Fahd Almalki,1 Mohammed S Samannodi,1 Hadeel A Khadawardi,1 Ahmad A Imam,1 Yosra A Turkistani,1 Fozya B Bashal,1 Abdullah Tawakul,1 Adeeb A Bulkhi,1 Mohammad S Dairi,1 Rania Zaini,3 Hani M Almoallim1 1Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia; 2Department of Medicine, Al Salama Hospital, Jeddah, Saudi Arabia; 3Department of Community Medicine, Umm Al-Qura University (UQU), Makkah, Saudi ArabiaCorrespondence: Hani M Almoallim, Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, Email hmmoalim@uqu.edu.saBackground: Entrustable professional activities (EPAs) define the core tasks that a graduating rheumatologist needs to perform independently in practice. The objective of this study was to develop and validate EPAs for rheumatology fellowship training programs in Saudi Arabia.Methods: Experts met to develop an initial set of potential end-of-training EPAs by conducting a comprehensive literature review of EPAs and studying the Saudi rheumatology fellowship curriculum. Then, to validate the EPAs, we conducted two rounds of the modified Delphi technique among rheumatology experts in Saudi Arabia. A response rate of 80% was considered and the minimum number of experts needed to be 25 to 30. Descriptive statistics were utilized to describe participants’ demographic characteristics and group responses to each statement in all rounds. The experts were asked to rate the relevancy of each EPA using a 5-point Likert scale in both Delphi rounds.Results: In the preliminary phase, four rheumatologists developed an initial set of 36 core EPAs for rheumatology training program in Saudi Arabia. For the two-rounds Delphi techniques, 32 experts were invited to complete the study. The response rate of the first and second round were, 78.12% (25) and 93.75% (30), respectively. The first-round Delphi resulted in a robust consensus on 31 EPAs for rheumatology training. Five EPAs were excluded, and one new EPA was proposed. In the subsequent round, all 32 EPAs achieved strong consensus. The eliminated EPAs likely fell short in one or more of the following areas: relevance to rheumatology practice in Saudi Arabia, overlapping with other EPAs, or practical challenges in the implementation.Conclusion: We have developed and validated a core set of EPAs for rheumatology fellowship training programs in Saudi Arabia. Mapping and identifying milestones for these EPAs are essential steps to follow to enhance workplace curriculum development.Keywords: entrustable professional activities, EPAs, rheumatology, training programs, fellowship, Saudi Arabia, curriculum, workplace