Reflexões após 3 anos: relatando o desabrochar de reumatologistas através de atividades profissionais confiabilizadoras.

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ABSTRACT Introduction: The 14 entrustable professional activities (EPAs) approved by the American College of Rheumatology (ACR) were developed to be “the comprehensive set of tasks or responsibilities that any practicing rheumatologist should be capable of performing”. Our goal was to originally present and discuss the 3-year experience of regularly assessing rheumatology residents through ACR-approved EPAs. Experience report: In this case series, all first-year and second-year rheumatology residents were assessed every May and November (the residency program starts in March) via online anonymous forms. For the EPA assessment, preceptors chose 1 of 5 levels of entrustability. Unsupervised practice was defined as levels 4 (“I had to provide minor directions”) and 5 (“I did not need to provide directions for safe and independent care”) combined. Individual reports were discussed by the program supervisor in separate feedback meetings. Between 2021 and 2023, 276 EPA reports from 11 residents assessed by 10 preceptors were analyzed. The number of EPAs with over 90% of unsupervised practice rating in semesters 1, 2, 3 and 4 were, respectively, 1, 0, 2 and 11. Overall progression was statistically significant for 13 EPAs and greater between semesters 2 and 3. Feedback meetings with an agenda for residents and for the program supervisor contributed to individual improvement and training qualification. Discussion: Implementing EPAs in rheumatology residency was an opportunity to increase feedbacks and to qualify the program. The residents’ autonomy was practically nonexistent before the last assessment. Although a valuable formative instrument in residency, the entrustable professional activity-based assessment needs careful discussion before the adoption of cut-off values for summative purposes. Conclusions: Assessing rheumatology residents through the ACR-approved EPAs establishes a regular feedback culture, providing opportunity for graduate students’ improvement and program qualification. Unsupervised practice was mostly achieved by the end of the training and a greater increment coincided with the change in the year of residency.