Developing a national clinical competency committee for family medicine training, South Africa

Abstract

Entrustable professional activities (EPAs) have been introduced into family medicine training programmes across South Africa (SA) as part of a competency-based medical education (CBME) framework. These EPAs provide a structured approach to assessing and developing the competencies required for independent practice in family medicine. Twenty-two EPAs, aligned with the scope of family medicine in SA, were identified and integrated into a national electronic portfolio of learning (ePOL), Scorion. This allows for continuous documentation, assessment, and feedback, supporting both registrars and supervisors in tracking progress. To ensure a robust assessment of competence and readiness for entrustment decisions, local and national clinical competency committees (CCCs) were established. Local CCCs operate within training institutions, comprising faculty teams that review registrar performance data from the ePOL to make entrustment decisions on specific EPAs. The national CCC, comprising of representatives from all nine family medicine departments in SA, provides oversight, ensures standardisation, and addresses inter-institutional variability in assessments.

Contribution: The implementation of EPAs and CCCs represents a significant advancement in family medicine education, fostering accountability, consistency, and transparency in assessment. Initial outcomes suggest improved alignment between training and workplace requirements, enhanced feedback quality, and better preparation for independent practice. Challenges remain, including ensuring faculty development, managing workloads, and fostering a culture of continuous quality improvement. Future steps include further refining the CCC framework, addressing implementation challenges and exploring the impact of these changes on registrar training and assessment.