Entrustable Professional Activities: Do General Surgery Residents Trust Them?

Abstract

The American Board of Surgery has initiated a pilot study to investigate the incorporation of Entrustable Professional Activities (EPAs) into the training of general surgery residents (GSR). Limited data exist on perception of EPAs by GSR. We aimed to assess the impact of EPAs on GSR for 2 included program topics: inguinal hernia and general surgery consultation. A 21-question, cross-sectional, Likert scale survey was distributed to 64 GSR at an urban university hospital to assess perceptions and apprehensions regarding EPA implementation. The Mann-Whitney U test was used to analyze differences in responses between junior residents (PGY 1-3) and senior residents (PGY 4-5), and by gender of respondent, α = 0.05. Forty-one (64%) GSR completed surveys. Approximately one-half of respondents had "faint to some" knowledge about EPAs. Fifty-seven percent of GSR were "moderately to highly concerned" about being assessed by attending surgeons with whom they did not have a prior relationship. Additionally, concerns were raised about being assessed by attending surgeons who may have observed their patient interaction only in part. Most GSR expressed "little to no concern" about impact of EPAs to potentially increase workload, the view of their program director as to their clinical competency, or American Board of Surgery plans to use collected data. Forty-two percent GSR in PGY 1 to 3 were "moderately to highly" concerned about impact on progression to the next year of residency, whereas senior GSR had "little to no concern." Most GSR (57%) expressed "moderate to high" concern about emergency medicine attending physicians evaluating them. Similar themes regarding EMA evaluation were identified in the comments section of the survey. EPAs are intended to be a major part of GSR's competency-based assessment and advancement. More work needs to be done to alleviate concerns as to who should provide assessments, as well as in defining how EPAs will be used to assess clinical competency.