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

The American Board of Surgery has proposed a competency-based training model, which relies on entrustable professional activities (EPAs) to assess and document competence. No data exist defining competence for surgical consultation, one of five proposed trial EPAs.

Qualitative interviews performed with 23 surgical faculty at two academic institutions. Interviews were reviewed for thematic content.

No explicit framework is currently used to evaluate the surgical consult. Most participants currently use subjective, global performance assessment. This method often relies on information not limited to the discrete consult at hand. Competence for a discrete surgical consult can be defined by six key procedural steps and six performance traits. Five red-flag behaviors were identified that negatively impact entrustability.

Subjective global assessment of resident performance can be problematic. We propose an objective framework for assessment, which can be used to develop an evaluation tool and inform entrustment decisions for competency-based training.