Date of Award

10-7-2025

Degree Type

Thesis

Degree Name

Master of Health Professions Education (MPHE)

First Advisor

Dr Qamar Riaz

Second Advisor

Dr Shaista Afzal

Third Advisor

Professor Alan Schwartz

Department

Educational Development

Abstract

Background: Competency-Based Medical Education (CBME) has gained global traction, with Entrustable Professional Activities (EPAs) serving as a key framework for translating competencies into practice. While EPAs for pediatric surgery have been developed in Canada and the United States, these reflect their institutional resources and clinical contexts. In Pakistan, despite recent initiatives by the College of Physicians and Surgeons Pakistan (CPSP) to integrate workplace-based assessment, no structured framework of EPAs exists for pediatric surgery training.
Objectives: This study aimed to develop and validate contextually appropriate EPAs for pediatric surgery residency training at Aga Khan University (AKU), with the broader goal of establishing a framework adaptable across Pakistan.
Methods: A qualitative, consensus-driven design was employed using a Modified Delphi technique. Faculty participants, selected for their supervisory and examining experience, engaged in iterative rounds of feedback to identify and refine core EPAs. The EQual rubric was applied to ensure validity, international credibility, and alignment with best practices. Draft EPAs were revised through successive rounds until consensus was achieved. Suggestions not consistent with core EPA principles (e.g., exclusive focus on surgical procedures, or expansion beyond training scope) were excluded, while contextually aligned inputs were incorporated into the final framework.
Results: The process resulted in the development of 12 pediatric surgery EPAs tailored to Pakistan’s clinical and training realities. These EPAs emphasize essential, observable, and measurable professional tasks within the scope of pediatric surgery. Endorsement by an expert panel underscored their content validity and relevance to the national training environment, while also demonstrating the feasibility of adapting global frameworks to local contexts.
Conclusion: This study represents the first systematic effort to define and validate EPAs for pediatric surgery training in Pakistan. Using a Modified Delphi approach and the EQual rubric, contextually appropriate EPAs were developed that remain consistent with international CBME frameworks. While the validation establishes their conceptual robustness, further work is needed to assess feasibility and impact in practice. This initiative provides a structured foundation for residency training, advances competency-based surgical education nationally, and contributes to the discourse on contextual adaptation of EPAs in low- and middle-income countries.

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1

Last Page

71

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