Implementing Entrustable Professional Activities: Evaluation and Insights from Undergraduate Occupational Therapy Clinical Practice Education in Singapore

Document Type (Journals)

Original Research

Abstract

Competency-based education is widely adopted in occupational therapy programs, yet translating broad competency frameworks into authentic clinical assessment remains challenging. Entrustable Professional Activities (EPAs) offer an outcome-oriented approach by integrating multiple competencies into observable clinical tasks. This study evaluated the implementation of a nationwide EPA framework alongside an established competency-based assessment tool within an undergraduate occupational therapy clinical practice education program in Singapore. Guided by the 2018 Ottawa Consensus Framework for Good Assessment, this qualitative evaluation study conducted seven focus group discussions with 18 occupational therapy clinical educators and 12 students who experienced the integrated EPA and competency-based assessment system. The Ottawa framework informed both the focus group guide and deductive content analysis. Coded segments were classified as positive or negative based on participants’ perceptions of the extent to which the EPA framework met the seven criteria for good assessment. Five criteria—coherent, continuous, feasible, purposes-driven, and acceptable were predominantly rated positively (>60%). Participants perceived that EPAs aligned well with the occupational therapy process, supported progressive autonomy, and clarified learning expectations. Mixed perceptions were reported for comprehensive and transparent and free of bias criteria, with challenges related to administrative burden, inconsistent understanding of entrustment decisions, and uncertainty regarding the relationship between EPAs and the summative competency assessment. Clinical educators and students generally perceived EPAs as a valuable complement to an established competency-based assessment system in undergraduate occupational therapy clinical practice education. Clear alignment with learning outcomes, ongoing refinement, and targeted preparation for educators and students were identified as important factors supporting implementation.

Biography

Corresponding author:

Heidi Siew Khoon Tan is an Associate Professor at the Singapore Institute of Technology and Senior Principal Occupational Therapist at Tan Tock Seng Hospital. She leads the implementation of EPA framework in undergraduate OT clinical practice education to advance practice readiness, competency-based education and quality assurance in occupational therapy education.

Co-authors:

Gabriel Wu-Xin Kwek is a Lead Professional Officer at the Singapore Institute of Technology and Co-Chair of the Health Sciences Clinical Practice Education committee. He supports the integration of EPAs into teaching and evaluation processes to align educational outcomes with workplace expectations and professional practice standards.

Corrine Kar Ling Hoo is a Senior Lecturer at the Singapore Institute of Technology. A seasoned OT educator, she has experience in curriculum design and learner development and applies EPAs to support enhance learner progression and foster meaningful feedback in both academic and clinical learning contexts.

Florence Wai Fong Cheong is an Adjunct Associate Professor at the Singapore Institute of Technology and Senior Principal Occupational Therapist at Tan Tock Seng Hospital. As former Co-Chair of the Ministry of Health OT panel, she led the development of OT EPAs, which focuses on practice-ready graduate development to meet local population health needs.

Muhammad Rahizan Zainuldin is an Associate Professor and Program Leader, Master of Health Sciences at the Singapore Institute of Technology. He champions teaching and assessment innovation, leveraging EPAs to enhance student supervision and performance evaluation in physiotherapy and practice readiness in allied health education programs.

Declaration of Interest

The authors report no declarations of interest.

Recommended Citation

Tan, H., Kwek, G., Hoo, C., Cheong, F., & Zainuldin, M. (2026). Implementing Entrustable Professional Activities: Evaluation and Insights from Undergraduate Occupational Therapy Clinical Practice Education in Singapore. Journal of Occupational Therapy Education, 10 (4). Retrieved from https://encompass.eku.edu/jote/vol10/iss4/14