A passport to practice or an administrative burden? A qualitative study of EPA-based E-portfolios in undergraduate medical education

INTRODUCTION: In undergraduate medical education (UME), the implementation of Competency-Based Medical Education (CBME) has led to the widespread use of Entrustable Professional Activities (EPAs) and electronic portfolios. Although EPA-based e-portfolios are intended to scaffold learning, reflection, and progressive clinical autonomy, their educational effects in undergraduate clinical clerkships remain insufficiently explored. This study examines how students and supervisors experience and interpret an EPA-based electronic portfolio in workplace-based undergraduate training. METHODS: Using an interpretivist qualitative design, we conducted peer-facilitated focus groups with undergraduate medical students and clinical supervisors at a Swiss medical faculty following four years of EPA-based e-portfolio implementation. Data were analysed using reflexive thematic analysis to explore how stakeholders made sense of the portfolio and how its digital structure shaped learning, assessment, and supervision practices. RESULTS: Three interconnected themes were identified. First, the EPA-based e-portfolio functioned as a learning scaffold and a legitimising 'passport', enabling students to claim clinical agency and access learning opportunities in the workplace. Second, a 'granularity paradox' emerged, whereby the digital entrustment scale imposed an assessment ceiling that failed to capture nuanced learning progression during short undergraduate rotations. Third, excessive documentation requirements, delayed entrustment, and perceptions of surveillance transformed the portfolio into a bureaucratic burden, eroding feedback quality and straining student-supervisor relationships. DISCUSSION: EPA-based e-portfolios can legitimise undergraduate students' clinical participation and scaffold reflective practice; however, their implementation within short clerkships reveals critical limitations. Digital entrustment scales tend to flatten meaningful progression, whilst excessive documentation requirements risk transforming portfolios into bureaucratic rituals at the expense of genuine feedback dialogue. The resulting assessment pressure fosters a perception of surveillance that undermines student well-being and erodes supervisory relationships. These findings suggest that EPA-based portfolios can support undergraduate learning only when simplified, developmentally aligned, and embedded within a structured supervisory framework.