Entrustable Professional Activity-Based Summative Performance Assessment in the Surgery Clerkship.

Area of Science:

• Medical Education
• Surgical Training
• Assessment

Background:

• Traditional clinical performance assessments in medical education may lack granularity.
• Entrustable Professional Activities (EPAs) offer a framework for competency-based assessment.
• Evaluating the utility of EPAs in summative assessments is crucial for curriculum development.

Purpose of the Study:

• To evaluate the performance of Entrustable Professional Activities (EPAs) in the summative assessment of third-year medical students during their surgery clerkship.
• To compare the effectiveness of EPAs against traditional clinical performance assessment tools.

Main Methods:

• Prospective collection of EPA assessments from a minimum of 4 evaluators per rotation for third-year medical students.
• Calculation of aggregate EPA scores and comparison with Clinical Performance Appraisal (CPA) scores, National Board of Medical Examiners (NBME) exam scores, and objective structured clinical exam (OSCE) scores.
• Ordinal logistic regression analysis to identify EPAs associated with final clerkship grades.

Main Results:

• Aggregate EPA scores showed significantly higher variance among learners compared to CPA scores (p < 0.001).
• EPA scores correlated well with CPA scores (rho = 0.803) but showed weaker positive correlations with NBME (rho = 0.265) and OSCE (rho = 0.153) scores.
• Only EPA 6 (oral presentation of patients) was independently associated with final clerkship grades (OR = 10.05, p = 0.02).

Conclusions:

• Integrating EPAs into the summative assessment of medical students during surgery clerkships is feasible.
• EPA-based assessment demonstrates superior discrimination of clinical performance among learners compared to global assessments.
• EPAs have the potential to better identify both advanced learners and those requiring additional educational support.