Developing entrustable professional activities for clinical preceptors of Master of Nursing Specialist: A Delphi study.
Abstract
Background
Clinical preceptors play a critical role in bridging theory and practice in Master of Nursing Specialist (MNS) education, making valid assessment of their competencies essential. However, existing competency assessments often rely on broad subjective descriptors with limited observable behavioral indicators. Entrustable Professional Activities (EPAs) translate competencies into assessable and observable units of practice, but standardized EPAs for MNS preceptors have not been established.
Methods
This multiphase study was conducted in tertiary teaching hospitals in China. An initial set of EPAs was developed through a literature review and qualitative interviews with 15 stakeholders. Two rounds of Delphi consultation with 20 experts were conducted to refine the framework. The analytic hierarchy process (AHP) was used to determine weights to the EPAs, and the resulting framework was evaluated for reliability and content validity.
Results
The literature review and qualitative interviews generated an initial framework comprising four core EPAs, 15 sub-EPAs, and 43 specific observational items. Expert response rates were 100% and 95% across the two Delphi rounds, and Kendall's W increased from 0.144 to 0.316 (both p < 0.05), indicating increasing expert consensus. After two rounds of Delphi consultations, the final framework was refined to six core EPAs, 12 sub-EPAs, and 44 specific observational items. The six core EPAs encompassed: 1) Guide clinical nursing practice, 2) Deliver classroom-based teaching, 3) Manage nursing clinical placements, 4) Supervise clinical nursing research, 5) Support physical and psychological well-being, and 6) Facilitate career development. The framework demonstrated excellent internal consistency and content validity (Cronbach's α = 0.969, S-CVI/UA = 0.932).
Conclusions
The developed EPAs are scientifically robust and clinically applicable. They shift assessment from abstract competency descriptions to concrete, observable teaching behaviors, provide clear and objective evaluation benchmarks, and enable comprehensive multi-source assessment. These EPAs can be used for the selection, training, evaluation, and professional development of MNS clinical preceptors.