Evidências sobre o desenvolvimento e implementação de entrustable professional activities na graduação médica com enfoque na singularidade pediátrica
DOI:
https://doi.org/10.5281/zenodo.21199561Palavras-chave:
Educação Baseada em Competências, Avaliação educacional, Educação médica, Atividades Profissionais ConfiáveisResumo
A Educação Médica Baseada em Competências traduz constructos teóricos em tarefas observáveis via Entrustable Professional Activities/EPAs. Na graduação, mitigar o "hiato de prontidão" para a residência é vital, especialmente na Pediatria, que exige competências técnicas e relacionais na tríade médico-paciente-cuidador. O estudo tem por objetivo identificar matrizes, modelos avaliativos e aplicações práticas das EPAs em pediatria para subsidiar tecnologias educacionais adaptadas à Região Norte do Brasil. Trata-se de uma Revisão integrativa (2021-2026) via protocolo PRISMA em seis bases (BVS, PubMed, Scopus, ERIC, CAPES, Google Scholar). Analisou-se qualitativamente 12 estudos do internato pediátrico sob a análise de conteúdo de Bardin. Os resultados evidenciam três eixos: 1) matrizes validadas por consenso e operacionalizadas por tecnologias ágeis (mobile e dashboards); 2) impacto positivo de intervenções experienciais (UTI pediátrica e cursos preparatórios) na prontidão discente; e 3) EPAs mitigando o "choque de transição" entre rodízios, cujos desafios esbarram na carga burocrática docente. Conclui-se que as EPAs constituem um modelo robusto, mas exigem validação ajustada ao contexto regional, rechaçando transposições acríticas do Norte Global. O sucesso requer integração longitudinal, ferramentas digitais eficientes, segurança psicológica discente e proteção do tempo clínico docente.
Palavras-chave: Educação Baseada em Competências. Avaliação educacional. Educação médica. Atividades Profissionais Confiáveis.
Referências
ALSHEIKH, M. H.; ZAINI, R. G.; IQBAL, M. Z. Developing and mapping entrustable professional activities with Saudi Meds Competency Framework: a consensus study. Advances in Medical Education and Practice, [s. l.], v. 13, p. 1367-1374, 2022.
ASSOCIATION OF AMERICAN MEDICAL COLLEGES. Core Entrustable Professional Activities for Entering Residency: curriculum developers’ guide. Washington, DC: AAMC, 2014. Disponível em: https://www.aamc.org/media/20211/download. Acesso em: 2 abr. 2026.
BARDIN, L. Análise de conteúdo. Edição revista e ampliada. São Paulo: Edições 70, 2016.
BAUMANN, L.; LATAL, B.; SEILER, M.; BENNINGER, S. K. Paediatric rotations in undergraduate medical education in Switzerland: meeting students’ expectations and the goals of the competency-based learning catalogue PROFILES. GMS Journal for Medical Education, [s. l.], v. 41, n. 5, p. Doc63, 2024.
BRASIL. Ministério da Educação. Conselho Nacional de Educação. Câmara de Educação Superior. Resolução CNE/CES nº 1, de 10 de janeiro de 2025: institui as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina. Brasília, DF: MEC, 2025.
BREMER, A. E.; RUCZYNSKI, L. I. A.; BLOT, P.; FLUIDO, C. R. M. G.; VAN DE POL, M. H. J. A. A qualitative study on how entrustable professional activities support medical students in their transitions across clerkships. Perspectives on Medical Education, [s. l.], v. 12, n. 1, p. 187-197, 2023.
BREMER, A. E.; SCHARENBORG, S. W.; FLUIDO, C. R. M. G.; VAN DE POL, M. H. J. A. A mixed-methods study on the course of professional identity formation in undergraduate medical students. BMC Medical Education, [s. l.], v. 25, n. 560, p. 1-15, 2025.
BUTANI, L.; PLANT, J.; BARONE, M. A.; DALLAGHAN, G. L. B. Entrustable professional activity-based assessments in undergraduate medical education: a survey of pediatric educators. Academic Pediatrics, [s. l.], v. 21, n. 5, p. 849-851, 2021.
CHEN, H. C.; VAN DEN BROEK, W. E. S.; TEN CATE, O. The case for use of entrustable professional activities in undergraduate medical education. Academic Medicine, [s. l.], v. 90, n. 4, p. 431-436, 2015.
DUGGAN, N.; CURRAN, V. R.; FAIRBRIDGE, N. A.; DEACON, D. D.; COOMBS, H.; STRINGER, K.; PENNELL, S. Using mobile technology in assessment of entrustable professional activities in undergraduate medical education. Perspectives on Medical Education, [s. l.], v. 10, p. 373-377, 2021.
FRANK, J. R.; SNELL, L.; SHERBINO, J. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada, 2015.
FRANCISCHETTI, I.; HOLZHAUSEN, Y.; PETERS, H. Entrustable professional activities for junior Brazilian medical students in community medicine. BMC Medical Education, [s. l.], v. 22, n. 737, p. 1-13, 2022.
GUMMESSON, C.; ALM, S.; CEDERBORG, A.; EKSTEDT, M.; HELLMAN, J. Entrustable professional activities (EPAs) for undergraduate medical education: development and exploration of social validity. BMC Medical Education, [s. l.], v. 23, n. 635, p. 1-13, 2023.
HA, E. L.; GLAESER, A. M.; WILHALME, H.; BRADDOCK, C. Assessing readiness: the impact of an experiential learning entrustable professional activity-based residency preparatory course. Medical Education Online, [s. l.], v. 29, n. 1, p. 1-11, 2024.
HASAN, R.; PHILLIPI, C.; SMERAGLIO, A.; BLANK, J.; SHUFORD, A.; BUDD, C.; GARCIA, A.; CARNEY, P. Implementing a real-time workplace-based assessment data collection system across an entire medical school’s clinical learning environment. MedEdPublish, [s. l.], v. 10, n. 1, p. 1-13, 2021.
HOBDAY, P. M.; BORMAN-SHOAP, E.; CULLEN, M. J.; ENGLANDER, R.; MURRAY, K. E. The Minnesota Method: a learner-driven, entrustable professional activity-based comprehensive program of assessment for medical students. Academic Medicine, [s. l.], v. 96, n. 7S, p. S50-S55, 2021.
HOLLAND, J. E.; ROHWER, J.; O’CONNOR, J.; WAHLBERG, K. J.; DE SARNO, M.; HOPKINS, W. E.; FLYER, J. N. Development, feasibility, and initial evaluation of an active learning module for teaching pediatric ECG interpretation and entrustable professional activities to clinical medical students. Academic Pediatrics, [s. l.], v. 23, n. 4, p. 883-885, 2023.
JOHNSON, R. R.; SHABANOVA, V.; LANGHAN, M. L. Insights into medical student pediatric intensive care unit rotations in developing essential skills for pediatric residency. Medical Science Educator, [s. l.], v. 35, p. 1195-1201, 2025.
KAR, S. S.; DUBE, R.; GEORGE, B. T.; BAIRY, L. K.; HAJEER, A. H.; MATALKA, I. I. A. Implementation of United Arab Emirates competency framework for medical education in undergraduate medical curriculum. BMC Medical Education, [s. l.], v. 25, n. 782, p. 1-15, 2025.
LAFEMINA, J.; AHUJA, V.; ALSEIDI, A.; BALTERS, M.; BRASEL, K.; CLARK, C.; DELMAN, K. A.; FARLEY, D.; LINDEMAN, B.; RELLES, D.; SHABAHANG, M.; SOHN, V.; HARRINGTON, D. APDS Consensus Statement: ideal senior medical student experiences for preparedness for general surgery internship. Journal of Surgical Education, [s. l.], v. 78, n. 1, p. 69-75, 2021.
LAMB, C. R.; SHAW, R. D.; HILTY, B. A.; WONG, S. L.; ROSENKRANZ, K. M. A targeted needs assessment for the development of a surgical sub-internship curriculum. Journal of Surgical Education, [s. l.], v. 78, n. 6, p. e121-e128, 2021.
LEE, R.; DHAMI, N.; GIBSON, W.; HAMZA, D.; OSWALD, A.; MOFFAT, M. Student perceptions of narrative feedback in entrustable professional activities. The Clinical Teacher, [s. l.], v. 22, p. 1-7, 2025.
NEVES, N. M. M.; VALE, C. C.; BOTELHO, N. M.; PEREIRA, L. J. M.; PORTELLA, M. B. Implementação de atividades profissionais confiáveis na graduação médica no Brasil: um mapeamento da literatura. In: SIMPÓSIO DE ENSINO E SAÚDE NA AMAZÔNIA, 3., 2025, Belém. Anais [...]. Belém: UEPA, 2025. p. 116-118.
MEYER, E. G.; HARVEY, E.; DURNING, S. J.; UIJTDEHAAGE, S. Pre-clerkship EPA assessments: a thematic analysis of rater cognition. BMC Medical Education, [s. l.], v. 22, n. 347, p. 1-12, 2022.
MEYER, E. G.; BOULET, J. R.; MONAHAN, P. B.; DURNING, S. J.; UIJTDEHAAGE, S. A pilot study of the generalizability of preclinical entrustment assessments in undergraduate medical education. Academic Medicine, [s. l.], v. 97, p. 562-568, 2022.
MILLHAM, L. R. I.; POTTER, J.; HIRSH, D. A.; TRINH, N. H.; ROYCE, C. S.; LEVY-CARRICK, N. C.; RITTENBERG, E. Incorporation of trauma-informed care into entrustable professional activities for medical student assessment. Academic Medicine, [s. l.], v. 100, n. 3, p. 290-296, 2024.
PAGE, M. J.; MCKENZIE, J. E.; BOSSUYT, P. M.; HOFFMANN, T. C.; MULROW, C. D.; SHAMSEER, L.; TETZLAFF, J. M.; AKL, E. A. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, [s. l.], v. 372, n. 71, p. 1-9, 2021.
POSTMES, L.; TAMMER, F.; POSTHUMUS, I.; WIJNEN-MEIJER, M.; VAN DER SCHAAF, M.; TEN CATE, O. EPA-based assessment: clinical teachers’ challenges when transitioning to a prospective entrustment-supervision scale. Medical Teacher, [s. l.], v. 43, n. 4, p. 404-410, 2021.
RODGERS, V.; TRIPATHI, J.; LOCKEMAN, K.; HELOU, M.; LEE, C.; RYAN, M. S. Development and pilot implementation of entrustable professional activities for pediatric clerkships. Academic Pediatrics, [s. l.], v. 21, n. 3, p. 556-563, 2021.
RYAN, M. S.; KHAN, A. R.; PARK, Y. S.; CHASTAIN, C.; PHILLIPI, C.; SANTEN, S. A.; BARRON, B. A.; OBESO, V.; YINGLING, S. L. Workplace-based entrustment scales for the Core EPAs: a multisite comparison of validity evidence for two proposed instruments using structured vignettes and trained raters. Academic Medicine, [s. l.], v. 97, n. 4, p. 544-551, 2022.
RYAN, M. S.; GIELISSEN, K. A.; SHIN, D.; PERERA, R. A.; GUSIC, M.; FERENCHICK, G.; OWNBY, A.; CUTRER, W. B.; OBESO, V.; SANTEN, S. A. How well do workplace-based assessments support summative entrustment decisions? A multi-institutional generalisability study. Medical Education, [s. l.], v. 58, n. 7, p. 825-837, 2024.
SCHWARTZ, A.; BORMAN-SHOAP, E.; CARRACCIO, C.; HERMAN, B.; HOBDAY, P. M.; KAUL, P.; LONG, M.; O’CONNOR, M.; MINK, R.; SCHUMACHER, D. J.; TURNER, D. A.; WEST, D. C. Learner levels of supervision across the continuum of pediatrics training. Academic Medicine, [s. l.], v. 96, n. 7S, p. S42-S49, 2021.
SILVA, M. X. E. Construção e validação de EPAs (Entrustable Professional Activities) para o ensino de pediatria na graduação em medicina. 2023. Dissertação (Mestrado em Ensino nas Ciências da Saúde) – Faculdades Pequeno Príncipe, Curitiba, 2023.
SOLOTKE, M. T.; CRABTREE, J.; CRON, J.; KALLEN, A.; ENCANDELA, J.; VASH-MARGITA, A. A multifaceted approach to evaluation in a pediatric and adolescent gynecology rotation for medical students. Journal of Pediatric and Adolescent Gynecology, [s. l.], v. 35, n. 3, p. 327-333, 2022.
TAYLOR, D. R.; PARK, Y. S.; EGAN, R.; CHAN, M. K.; KARPINSKI, J.; TOUCHIE, C.; SNELL, L. S.; TEKIAN, A. EQual, a novel rubric to evaluate entrustable professional activities for quality and structure. Academic Medicine, [s. l.], v. 92, n. 11S, p. S110-S117, 2017.
TEN CATE, O.; NEL, D.; HENNUS, M. P.; PETERS, S.; ROMAO, G. S. For which entrustable professional activities must medical students be prepared if unsupervised patient care without further training is an expectation? An international Global South study. BMJ Global Health, [s. l.], v. 9, n. 10, p. e016090, 2024.
TORRES, C.; SEGOVIA, J.; ARELLANO, F.; CAMPOS, F.; FECCI, C. Determinación de actividades profesionales confiables en una escuela de medicina en Chile. FEM: Revista de la Fundación Educación Médica, [s. l.], v. 24, n. 2, p. 77-83, 2021.
VIOLATO, C.; CULLEN, M. J.; ENGLANDER, R.; MURRAY, K. E.; HOBDAY, P. M.; BORMAN-SHOAP, E.; ERSAN, O. Validity evidence for assessing entrustable professional activities during undergraduate medical education. Academic Medicine, [s. l.], v. 96, n. 11S, p. S70-S75, 2021.
WEISSENBACHER, A.; BOLZ, R.; STEHR, S. N.; HEMPEL, G. Development and consensus of entrustable professional activities for final-year medical students in anaesthesiology. BMC Anesthesiology, [s. l.], v. 22, n. 128, p. 1-10, 2022.
ZACKOFF, M. W.; YOUNG, D.; SAHAY, R. D.; FEI, L.; REAL, F. J.; GUIOT, A.; LEHMANN, C.; KLEIN, M. Establishing objective measures of clinical competence in undergraduate medical education through immersive virtual reality. Academic Pediatrics, [s. l.], v. 21, n. 8, p. 1452-1459, 2021.
