Effects of an Entrustable Professional Activities (EPA) based Curriculum on the Teaching Performance of Clinical Nursing Instructors

Authors

  • Hsiao-Fang Chen Ministry of Health and Welfare, Tainan Hospital, West Central District, Tainan City 700, Taiwan; Department of Business and Operations Management, College of Management, Chang Jung Christian University, Guiren District, Tainan City 711, Taiwan https://orcid.org/0009-0000-8135-9098
  • Jin-Yuan Chern Department of Health Care Administration, Chang Jung Christian University, Guiren District, Tainan City 711, Taiwan, Taiwan https://orcid.org/0000-0003-1918-4201

DOI:

https://doi.org/10.31674/mjn.2026.v17i05.001

Abstract

Background: Traditional time-based nursing training may not ensure clinical competence. Therefore, the competency-based Entrustable Professional Activities (EPAs) teaching model has been introduced to help determine a medical trainee’s readiness for independent practice. This study aimed to evaluate the effectiveness of an EPAs measure on clinical instructors and novice nurses. Methods: From November 2023 to January 2025, a structured EPA-based curriculum comprising basic training, expert workshops, and lesson plan development was completed by 30 clinical nursing instructors. The Kirkpatrick four-level model was used for evaluation. Data collection included satisfaction surveys, self-assessment questionnaires, and EPAs entrustment level ratings for novice nurses. The trained instructors subsequently applied the EPA framework to supervise 9 novice nurses, generating 108 entrustment assessments across six biweekly evaluation cycles. Statistical analyses included paired-sample t-tests and the Friedman test. Between December 2024 and March 2025, 9 novice nurses demonstrated significant improvement in entrustment levels across six assessment cycles, with a concurrent downward trend in patient safety incidents. Results: Participants’ satisfaction averaged 4.81 on a 5 point scale. Significant improvements were observed in knowledge, confidence, and teaching skills (p < 0.001). Ten EPA-based lesson plans were developed and implemented in clinical practice. Conclusion: The EPA-based curriculum enhanced teaching effectiveness, novice nurse competence, and patient safety. This model has potential for broader adoption and future digital integration in nursing education. 

Keywords:

Clinical Nursing Instructor, Entrustable Professional Activities (EPAs), Kirkpatrick Model, Teaching Performance

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References

Alexander, N., Maaz, A., Peters, H., & Kottner, J. (2022). Entrustable professional activities in nursing education: a scoping review protocol. BMJ Open, 12(10), e061451. https://doi.org/10.1136/bmjopen-2022-061451

Alsalamah, A., & Callinan, C. (2022). The Kirkpatrick model for training evaluation: bibliometric analysis after 60 years (1959–2020). Industrial and Commercial Training, 54(1), 36-63. https://doi.org/10.1108/ICT-12-2020-0115

Andreou, V., Peters, S., Eggermont, J., & Schoenmakers, B. (2024). Co-designing entrustable professional activities in general practitioner’s training: a participatory research study. BMC Medical Education, 24(1), 549. https://doi.org/10.1186/s12909-024-05530-y

Anthamatten, A., & Pitts, C. (2024). Integration of entrustable professional activities in a Competency-Based clinical assessment tool in a nurse practitioner program. Nurse Educator, 49(5), 241-245. https://doi.org/10.1097/NNE.0000000000001697

Bryant, B. H., Anderson, S. R., Brissette, M., Childs, J. M., Gratzinger, D., Johnson, K., Powell, D. E., Zein-Eldin Powell, S., Timmons, C. F., Chute, D., Cummings, T. J., Furlong, M. A., Hébert, T. M., Reeves, H. M., Rush, D., Vitkovski, T., & McCloskey, C. B. (2024). National pilot of entrustable professional activities in pathology residency training. Academic Pathology, 11(2), 100110. https://doi.org/10.1016/j.acpath.2024.100110

Buanz, S. F., Alsenayien, A. Y., Altharman, H. A., Alnaqi, R. I., Llaguno, M. B. B., Mousa, O., & Siraj, R. A. (2024). Nursing students, faculty, and preceptors perception of effective characteristics of clinical instructor: A cross-sectional study. SAGE Open Nursing, 10, 23779608241298427. https://doi.org/10.1177/23779608241298427

Cate, O. T., (2005). Entrustability of professional activities and competency-based training. Medical Education, 39(12), 1176-1177. https://doi.org/10.1111/j.1365-2929.2005.02341.x

Cate, O. T., Chen, H. C., Hoff, R. G., Peters, H., Bok, H., & van der Schaaf, M. (2015). Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Medical Teacher, 37(11), 983-1002. https://doi.org/10.3109/0142159X.2015.1060308

Cotta, R. M. M., de Souza Ferreira, E., de Aguiar Franco, F., da Costa Souza Barros, G., Januário, J. P. T., Moreira, T. R., & Martín, R. L. (2024). The effectiveness of faculty development programs for training university professors in the health area: a systematic review and meta-analysis. BMC Medical Education, 24(1), 768. https://doi.org/10.1186/s12909-024-05735-1

Gallant, N. L., Oddone Paolucci, E., Russill, C. L., Jewett, R., Recsky, C., Ford, K., Idriss-Wheeler, D., Tseung, V., Ansari, H., Ladak, Z., Fernandes, A., & Marshall, D. A. (2026). Applications of the Kirkpatrick Model in Post-secondary Health Sciences Education: A Scoping Review. International Journal of Health Policy and Management, 15, e8857. https://doi.org/10.34172/ijhpm.8857

Ha, E. L., Glaeser, A. M., Wilhalme, H., & Braddock, C. (2024). Assessing readiness: The impact of an experiential learning entrustable professional activity-based residency preparatory course. Medical Education Online, 29(1). e2352217. https://doi.org/10.1080/10872981.2024.2352217

Han, S., Dong, W., Duan, X., Chen, F., Cao, G., Zhu, R., & Zhang, Q. (2026). Developing an Evaluation Framework Based on Entrustable Professional Activities for Advanced Practice Nurses in China. International Nursing Review, 73(1), e70151. https://doi.org/10.1111/inr.70151

Hu, S. H.-L., Tsay, S.-L., Huang, S.-S., Tung, H.-H., Chen, Y.-R., Lu, L.-C., Chang, C., Hu, J.-Y., & Hung, W.-C. (2025). Development and Validation of an Entrustable Professional Activity-Based Assessment Scale for Nurse Practitioners in Taiwan. Journal of Nursing Research, 33(4), e399. https://doi.org/10.1097/jnr.0000000000000682

Jarrett, J. B., Elmes-Patel, A. T., Allen, S. M., Djuric Kachlic, M., Schriever, A. E., Driscoll, T. P., ... & Schwartz, A. (2025). Longitudinal preceptor assessment of entrustable professional activities across Introductory and Advanced Pharmacy Practice Experiences. Pharmacy, 13(3), 72. https://doi.org/10.3390/pharmacy13030072

Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick's four levels of training evaluation. Association for Talent Development.

Lau, S. T., Ang, E., Samarasekera, D. D., & Shorey, S. (2020). Evaluation of an undergraduate nursing entrustable professional activities framework: An exploratory qualitative research. Nurse Education Today, 87, 104343. https://doi.org/10.1016/j.nedt.2020.104343

Liu, W. L., Chen, L., Zhang, L., Yang, L., & Fu, M. Y. (2026). Reframing the Kirkpatrick Model for Evaluating Humanistic Care Training in Nursing: A Context-Sensitive Integrative Perspective. Frontiers in Public Health, 14, 1789683. https://doi.org/10.3389/fpubh.2026.1789683

Meng, Z., Haidan, C., Junye, T., Qian, L., Xin, Q., & Cheng, W. (2024). Development of entrustable professional activities for novice nurses: A modified Delphi study. Nurse Education in Practice, 81, 104181. https://doi.org/10.1016/j.nepr.2024.104181

Moore, J., Chan, T., Doucette, J., Lipps, T., & Slager, D. (2024). Defining nurse practitioner core entrustable professional activities: essential step toward competency-based education. Nurse Educator, 49(5), 235-240. https://doi.org/10.1097/NNE.0000000000001673

Nixon, L. J., Poeppelman, R. S., Traxler, M., & Violato, C. (2026). Assessing core entrustable professional activities in the pre-clerkship phase of undergraduate medical education. Academic Medicine, wvag059. https://doi.org/10.1093/acamed/wvag059

Park, S., Chiang, N. J., Nyhof-Young, J., Rojas, D., Lazor, J., & Sirianni, G. (2023). Entrustable professional activities in undergraduate medical education: A needs assessment of medical students and faculty. Education in the Health Professions, 6(2), 92-95. https://doi.org/10.4103/EHP.EHP_3_23

Pereira, F., Lehmann-Wellig, B., & Verloo, H. (2025). Enhancing beliefs and implementation of evidence-based practice among undergraduate nurses using a multi-component educational programme: a pre–post study. BMC Medical Education, 25(1), 531. https://doi.org/10.1186/s12909-025-07121-x

Pietsch, J., Maaz, A., & Kottner, J. (2025). Entrustable professional activities in nursing education: a scoping review. BMJ Open, 15(5), e094609. https://doi.org/10.1136/bmjopen-2024-094609

Sefton, K., Harder, N., & Kramer, M. (2025). Mentorship outcomes for clinical nursing instructors: A scoping review. Teaching and Learning in Nursing, 20(3), 261-267. https://doi.org/10.1016/j.teln.2025.02.021

Willetts, G., & Maguire, T. (2025). The Natural Progression for Nursing Practice:" Competency‐Based Frameworks" to" Entrustable Professional Activities". Nursing & Health Sciences, 27(1). https://doi.org/10.1111/nhs.70065

Published

25-05-2026

How to Cite

Chen, H.-F., & Chern, J.-Y. . (2026). Effects of an Entrustable Professional Activities (EPA) based Curriculum on the Teaching Performance of Clinical Nursing Instructors. The Malaysian Journal of Nursing (MJN), 17(5), 01-11. https://doi.org/10.31674/mjn.2026.v17i05.001

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