Validity and Educational Impact of Clinical Entrustable Professional Activities Linked to the Nutrition Care Process for Work-Based Assessment of Entry-Level Dietetics Students: Evaluation of a 3-Year Implementation Study in Australia

Published:September 08, 2022DOI:



      Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment.


      To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings.


      Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed.

      Participants and setting

      Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals.

      Main outcome measures

      Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment.

      Statistical analyses performed

      Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA.


      Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs.


      The tool’s construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching.


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      A. Bramley is Allied Health Education Lead, Monash Health, Clayton, Vic, Australia, and an adjunct senior lecturer, Dietetics and Human Nutrition, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia.


      A. Forsyth is an Associate Professor, Dietetics and Nutrition, Australian Catholic University, City, State, Australia, and an adjunct associate professor, Dietetics and Human Nutrition, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia.


      L. McKenna is Dean and Head, School of Nursing and Midwifery, College of Science, Health, and Engineering, La Trobe University, Bundoora, Victoria, Australia.