Introduction: Entrustable Professional Activity (EPA)-based residency programmes are designed to offer structure, flexibility, and a gradual increase in autonomy. While residents are expected to take an active role in their learning, little is known about how they actually experience learning and working within the EPA framework. This study explores paediatric residents’ experiences of learning, working, and developing within an EPA-based training programme.

Methods: We conducted a qualitative study using semi-structured interviews with 11 paediatric residents from three of the seven Dutch training regions. Interviews were transcribed verbatim, anonymised, and analysed using template analysis to identify themes related to residents’ learning and professional development within EPA-based training.

Results: Residents described increasing confidence and competence in the phase prior to entrustment. Some linked this development to the EPA structure, as it supported goal setting and feedback-seeking, while others attributed this development primarily to learning through clinical experience.

The entrustment decision process—particularly the Clinical Competence Committee (CCC) feedback—was seen as reassuring, though residents also described discomfort with being evaluated by a group. After entrustment, residents experienced greater autonomy but noted variation in supervision practices. Some felt unsure about when to request supervision, particularly in apparently straightforward settings. Others described feeling empowered to pursue individualised learning opportunities.

Discussion: In reflecting on these findings, we drew on the concept of Self-Regulated Learning to explore how residents engaged with their training. Making these principles more explicit within EPA-based programmes may support residents in optimising their learning and strengthen their preparation for independent practice.