Entrustable professional activities (EPAs) serve as a critical instrument bridging competency frameworks and clinical practice, and have garnered widespread attention in medical education both domestically and internationally. This article systematically reviews the origin, theoretical framework, and operational mechanisms of EPAs, summarizes their current application status and developmental trajectory in medical education across China and other countries, and provides an in-depth analysis of the core challenges confronting the localization of EPAs in China, including insufficient multi-center validation, lack of unified evaluation standards, poor articulation across training stages, and incomplete implementation conditions. On this basis, and in consideration of China′s medical education policy environment and practical needs, this article proposes strategic pathways for future localization efforts, with the aim of providing a reference for further research and practical promotion of EPAs in China.