Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs

Area of Science:

• Medical Education
• Surgical Training Assessment

Background:

• The American Board of Surgery advocates for competency-based education in surgical training.
• A national pilot study (2018-2020) explored implementing Entrustable Professional Activities (EPAs) for common general surgical conditions across 28 programs.
• ACGME Milestones were also assessed by program clinical competency committees.

Purpose of the Study:

• To evaluate the validity of general surgery EPAs by comparing them with ACGME Milestone ratings.
• To assess the feasibility and correlation of EPA entrustment levels with established competency metrics.

Main Methods:

• Analysis of prospectively collected, de-identified data from the EPA Pilot Study.
• Correlation analysis (Spearman's rho) between EPA entrustment scores (1-5) and ACGME Milestone subcompetency ratings (1-5).
• Specific EPAs studied included gallbladder, inguinal hernia, right lower quadrant pain, trauma, and consults.

Main Results:

• A total of 493 residents' data were analyzed.
• EPA summative entrustment scores demonstrated moderate-to-strong positive correlations with mapped Milestone subcompetencies (median rho = 0.703).
• Correlations varied by EPA, with higher correlations for operative procedures like right lower quadrant pain (rho=0.833) and lower for consults (rho=0.455).

Conclusions:

• Entrustable Professional Activities (EPAs) exhibit moderate-to-strong positive correlations with key Milestones in general surgery.
• These findings support the validity of EPAs as an assessment tool in surgical education.
• EPA assessments can effectively inform Milestone ratings provided by clinical competency committees.