How well do faculty do in providing general surgery EPA feedback?

Area of Science:

• Medical Education
• Surgical Training
• Competency-Based Assessment

Background:

• Entrustable Professional Activities (EPAs) are crucial for competency-based assessment in surgery.
• EPAs define observable trainee behaviors at progressive autonomy levels.
• The American Board of Surgery mandates EPA assessment for General Surgery residency programs.

Purpose of the Study:

• To analyze faculty feedback on surgical residents' EPAs for alignment with descriptors.
• To evaluate the provision of actionable feedback for resident skill development.
• To identify areas for improvement in faculty assessment comments.

Main Methods:

• Evaluated 540 General Surgery EPA assessments (inguinal hernia, gallbladder, appendicitis, trauma, consultation) from 6/2021-12/2022.
• Assessed free text comments for alignment with EPA behavior descriptions and entrustment levels.
• Rated comments on a binary scale (Align/Not Align) with independent evaluators.
• Analyzed comments for behavioral descriptions, improvement suggestions, and feedback valence.

Main Results:

• 77% of EPA microassessments showed alignment between autonomy level and feedback.
• Feedback often misaligned autonomy levels (e.g., rating independent practice with comments indicating supervision needed).
• 28.3% of feedback included actionable suggestions for improvement.

Conclusions:

• Most faculty feedback aligns with EPA behavioral anchors but often lacks actionable guidance for advancing entrustment.
• Clearer feedback, anchored in EPA behaviors and projecting progression, can guide resident skill development.
• Faculty development should prioritize actionable feedback to enhance resident advancement trajectories.