The surgical consult entrustable professional activity (EPA): Defining competence as a basis for evaluation

Area of Science:

• Surgical Education
• Competency-Based Training
• Medical Assessment

Background:

• The American Board of Surgery is implementing competency-based training using entrustable professional activities (EPAs).
• No established definition of competence currently exists for surgical consultation, a key EPA.

Purpose of the Study:

• To define competence for surgical consultation.
• To develop an objective framework for evaluating surgical consults.
• To inform entrustment decisions in competency-based surgical training.

Main Methods:

• Qualitative interviews were conducted with 23 surgical faculty members at two academic institutions.
• Interview data were analyzed for thematic content to identify key elements of competence.

Main Results:

• Current evaluation of surgical consults is largely subjective and global, often incorporating extraneous information.
• Competence in surgical consultation can be objectively defined by six procedural steps and six performance traits.
• Five specific "red-flag" behaviors were identified that detract from entrustability.

Conclusions:

• Subjective global assessments of resident performance are problematic.
• An objective framework for evaluating surgical consults is proposed.
• This framework can guide the development of assessment tools and entrustment decisions for competency-based training.