Assessment of Ethical Competence as an Entrustable Professional Activity (EPA) among MBBS Interns: A Cross-Sectional Mixed-Methods Study

Background Ethical competence is a core component of professional practice in medical training and is central to the Attitude, Ethics, and Communication (AETCOM) framework under Competency-Based Medical Education (CBME) in India. Entrustable Professional Activities (EPAs) offer a structured approach to assessing clinical and ethical readiness during internship. However, evidence on the alignment between ethical competence and EPA-based entrustment among MBBS interns remains limited. Methods A cross-sectional mixed-methods study was conducted among 100 MBBS interns at a tertiary care teaching hospital. Interns completed a validated self-assessment questionnaire on ethical competence, while faculty independently rated interns’ entrustment levels using EPA-based tools. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression. Qualitative data from open-ended responses were analyzed using thematic analysis following the Braun and Clarke framework. Integration of findings was achieved through joint display analysis. Results Seventy percent of interns demonstrated satisfactory entrustment (EPA ≥ 3). Interns with higher self-assessed scores, prior ethics training, and longer internship duration were significantly more likely to achieve EPA ≥ 3 (p < 0.05). Self-assessment scores were consistently higher than faculty ratings (p < 0.001). Qualitative analysis identified system-related constraints, hierarchical barriers, role ambiguity, and the need for structured ethics training as key themes influencing ethical practice. Integration of findings revealed that contextual and organizational factors were strongly associated with lower entrustment levels. Conclusion Ethical competence among interns is influenced by individual preparedness and systemic factors. EPA-based assessment provides a meaningful framework for evaluating ethical readiness. Strengthening structured ethics training may enhance ethical entrustment and professionalism.