Currently submitted to: JMIR Medical Education
Date Submitted: Nov 11, 2025
Open Peer Review Period: Nov 20, 2025 - Jan 15, 2026
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Medical Students' Acceptance of Digital Entrustable Professional Activities: Results of a Cohort Study
ABSTRACT
Background:
Digital Entrustable Professional Activities (EPAs) in simulated environments may accelerate competency acquisition, but adoption depends on learner acceptance. The Technology Acceptance Model (TAM) posits that perceived usefulness (PU) and perceived ease of use (PEU) shape attitudes (AT) and, in turn, behavioral intention (BI).
Objective:
We examined medical students’ acceptance of digital EPAs and tested the hypothesized TAM relationships among PU, PEU, AT, and BI.
Methods:
Clinical-phase medical students at Ludwig-Maximilians-Universität Munich completed a TAM-based survey (7-point Likert scales) after reading a canonical analog EPA and its digital counterpart. Confirmatory analyses comprised bivariate correlations, and hierarchical regressions testing TAM paths. Exploratory analyses comprised paired-sample t-tests comparing analog vs digital ratings and path modeling to evaluate global TAM fit.
Results:
N = 72 medical students provided complete responses per construct. Mean ratings were favorable (≈5/7). Internal consistency was acceptable (ω=.67–.80). Within the digital EPAs, PU strongly predicted AT (β=.59, p<.001), and AT predicted BI (β=.58, p<.001. For the analog EPAs, PU (β=.54, p<.001) and PEU (β=.28, p=.005) predicted AT; both AT (β=.42, p<.001) and PU (β=.36, p=.002) predicted BI. Attitudes were modestly higher for analog vs digital (M=5.18 vs 4.87; t(71)=−2.50, p=.015, d=−0.30) but PU, PEU, BI did not differ significantly. The path models indicated excellent fit for both formats (CFI=1.00; RMSEA=0.00; SRMR≤.01).
Conclusions:
Students reported high acceptance of digital EPAs. Acceptance was driven primarily by PU (via AT), whereas PEU contributed to AT only for analog EPAs. Implementation should emphasize demonstrable educational value and cultivate positive attitudes; subsequent work should link acceptance to actual use and learning outcomes. Clinical Trial: PRR1-10.2196/59326
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