P.178 Neurosurgical Faculty Expectations of Entrustable Professional Activities Evaluations

Abstract

Background: Competence by Design (CBD), a new outcomes-based approach to medical education, has been recently introduced into neurosurgical programs across Canada. A cornerstone of this educational paradigm shift requires evaluation of residents’ performances of entrustable professional activities (EPAs). This study aimed to define Faculty expectations and markers of competence for resident EPA performances. Methods: Canada-wide survey of neurosurgical Faculty (NSF) with a 55-item online questionnaire referencing 15/45 available core neurosurgery EPAs. Results: Of the 52 respondents, majority believed that being able to perform safely (98%), effectively (92%) and independently (90%) and being able to adapt to contextual complexities of the case (88%) and unexpected events (88%) represented necessary qualities for demonstrating competence achievement of an EPA. Performing efficiently, without supervision and responding to rare events were all considered less important. On average, NSF believed that at least five separate assessments involving two or more different assessors were necessary for documenting competence achievement of each EPA. Proportion believing EPAs were representative of general neurosurgery competences varied significantly across all EPAs (p<0.00001) with >25% believing 5/15 EPAs required fellowship training. Conclusions: This study defined expectations and indicators of competent surgical performance and revealed a significant debate regarding perceived appropriateness of current EPAs for general neurosurgical training.