Evaluating the Quality of Narrative Feedback for Entrustable Professional Activities in a Surgery Residency Program

To assess the quality of narrative feedback given to surgical residents during the first 5 years of competency-based medical education implementation.

Competency-based medical education requires ongoing formative assessments and feedback on learners' performance.

We conducted a retrospective cross-sectional study using assessments of entrustable professional activities (EPAs) in the Surgical Foundations curriculum at Queen's University from 2017 to 2022. Two raters independently evaluated the quality of narrative feedback using the Quality of Assessment of Learning score (0-5).

A total of 3900 EPA assessments were completed over 5 years. Of assessments, 57% (2229/3900) had narrative feedback documented with a mean Quality of Assessment of Learning score of 2.16 ± 1.49. Of these, 1614 (72.4%) provided evidence about the resident's performance, 951 (42.7%) provided suggestions for improvement, and 499/2229 (22.4%) connected suggestions to the evidence. There was no meaningful change in narrative feedback quality over time ( r = 0.067, P = 0.002). Variables associated with lower quality of narrative feedback include: attending role (2.04 ± 1.48) compared with the medical student (3.13 ± 1.12, P < 0.001) and clinical fellow (2.47 ± 1.54, P < 0.001), concordant specialties between the assessor and learner (2.06 ± 1.50 vs 2.21 ± 1.49, P = 0.025), completion of the assessment 1 month or more after the encounter versus 1 week (1.85 ± 1.48 vs 2.23 ± 1.49, P < 0.001), and resident entrusted versus not entrusted to perform the assessed EPA (2.13 ± 1.45 vs 2.35 ± 1.66; P = 0.008). The quality of narrative feedback was similar for assessments completed under direct and indirect observation (2.18 ± 1.47 vs 2.06 ± 1.54; P = 0.153).

Just over half of the EPA assessments of surgery residents contained narrative feedback with overall fair quality. There was no meaningful change in the quality of feedback over 5 years. These findings prompt future research and faculty development.