Association Between Entrustable Professional Activities and Milestones Evaluations: Real-time Assessments Correlate...

Area of Science:

• Medical Education
• Surgical Training
• Competency-Based Assessment

Background:

• Entrustable professional activities (EPAs) are emerging tools for refining competency-based medical education.
• The American Board of Surgery is piloting EPAs to assess their impact on surgical resident evaluation and feedback.
• The relationship between EPAs and the ACGME Milestones in Surgery, a semiannual competency assessment, is not well-defined.

Purpose of the Study:

• To evaluate the correlation between a specific EPA for cholecystectomy and the corresponding elements of the ACGME Milestones in Surgery.
• To compare the effectiveness of EPAs against existing milestone evaluations in surgical residency.

Main Methods:

• A pilot study involving general surgery residents at SUNY Upstate Medical University from July 2018 to October 2019.
• EPA entrustability ratings (0-4) for gall bladder surgery were collected and compared with semiannual Milestones scores (0-4).
• Spearman rank correlation was used to analyze the association between EPA rankings and Milestones scores for operative (PC3, MK2) and nonoperative (PC1, PC2, ICS3) components.

Main Results:

• Significant positive correlations were observed between the cholecystectomy EPA and Milestones scores for PC3 (ρ=0.690-0.876) and MK2 (ρ=0.759-0.882) (p < 0.001 for all).
• Positive correlations were also found between nonoperative Milestones (PC1, PC2, ICS3) and intraoperative EPA entrustability ratings.
• The study included 24 residents and 106 intraoperative EPA evaluations.

Conclusions:

• Significant correlations exist between EPAs for cholecystectomy and associated Milestones evaluation scores.
• EPAs show potential for providing more timely and specific feedback compared to current evaluation tools.
• EPAs may collectively improve formative feedback practices in surgical resident evaluations.