A Scoping Review of the Literature on Entrustable Professional Activities in Surgery Residency Programs

Area of Science:

• Medical Education
• Surgical Training
• Competency-Based Education

Background:

• Entrustable Professional Activities (EPAs) are widely used in postgraduate medical education, particularly in surgery residency programs, as a framework for assessing resident performance and providing feedback.
• Despite widespread adoption, there is limited evidence on the impact of EPAs on learners and the learning environment.
• Mapping the existing literature on EPAs in surgery is a crucial first step to understanding their role and effectiveness.

Purpose of the Study:

• To conduct a scoping review examining the nature, extent, and range of publications on the development, implementation, and assessment of EPAs in surgery.
• To identify experiences and factors influencing the practical implementation and use of EPAs within surgical specialties.

Main Methods:

• A scoping review methodology was employed.
• Searches were conducted across four electronic databases (Medline, Embase, Education Source, and ERIC) on January 20, 2022, with a subsequent search on July 19, 2023.
• Quasi-statistical content analysis was used to analyze 42 empirical and nonempirical articles focusing on EPA development, implementation, assessment, validity, reliability, and workplace experiences.

Main Results:

• The included articles covered four main themes: 1) development and refinement of EPAs for surgery residency, 2) methods for EPA implementation, 3) outcomes of EPA use in practice, and 4) barriers, facilitators, and areas for improvement.
• The analysis revealed a rapidly increasing number of publications on EPAs in surgical residency.

Conclusions:

• This review highlights key trends and gaps in the literature concerning EPAs in surgical residency, from initial development to workplace application.
• A significant gap identified is the lack of theoretical or conceptual underpinnings in existing EPA studies.
• Future research and implementation efforts should integrate implementation science frameworks to enhance the structure and operationalization of EPAs in surgical education.