Seeing potential opportunities for teaching (SPOT): Evaluating a bundle of interventions to augment entrustable professional activity acquisition.

Abstract

Within the Canadian competency-based medical education system, entrustable professional activities (EPAs) are used to assess residents on performed clinical duties. This study aimed to determine whether implementing a bundle of two interventions (a case-based discussion intervention and a rotation-based nudging system) could increase the number of EPA assessments that could occur for our trainees. The authors designed an intervention bundle with two components: 1) a case-based workshop where trainees discussed which EPAs could be assessed with multiple cases and 2) a nudging system wherein each trainee was reminded of EPAs that would be useful to them on each rotation in their first year. We conducted a retrospective program evaluation to compare the intervention cohort (2019) to two historical cohorts using similar EPAs (2017, 2018). Data from 22 trainees (seven in 2017, eight in 2018, and seven in 2019) were analyzed. There was a marked increase in the total number of EPA assessments acquired in the 2019 cohort (average per resident=285.7, 95% confidence interval [CI]= 256.1 to 312.3, range= 195-350) compared to the two other years (2018 [average=132.4, 95% CI= 107.5 to 157.02, range= 107-167] and 2017 [70.1, 95% CI 45.3 to 91.0, range= 49-95]), yielding an effect size of Cohen's d = 4.02 for our intervention bundle. Within the limitations of a small sample size, there was a strong effect of introducing two interventions (a case-based orientation and a nudging system) upon EPA assessments with PGY-1 residents. These strategies may be useful to others seeking to improve EPA assessment numbers in other specialties and clinical environments.