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The Path to Independence: Progression in Entrustment Reflected in Entrustable Professional Activity Ratings.

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Entrustable Professional Activities in endocrine surgery: A national pilot study.

Polina Zmijewski1, M Chandler McLeod1, Ramsha Akhund1

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Entrustment scores for endocrine surgery trainees improved significantly in the second half of the academic year. Trainees achieved higher entrustment earlier in preoperative and postoperative care compared to intraoperative phases.

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Area of Science:

  • Medical Education
  • Surgical Training
  • Endocrine Surgery

Background:

  • The American Association of Endocrine Surgeons developed Entrustable Professional Activities (EPAs) to standardize trainee assessment.
  • EPAs define core competencies essential for comprehensive endocrine surgery.

Purpose of the Study:

  • To evaluate the implementation and effectiveness of EPAs in assessing endocrine surgery trainees.
  • To analyze trainee performance and entrustment levels across different surgical phases and subspecialties.

Main Methods:

  • A multi-institutional study involving 10 institutions collected 698 microassessments of trainee performance on 14 defined EPAs.
  • Assessments utilized a 5-point entrustment scale via a web-based platform from July 2022 to September 2023.

Main Results:

  • Trainee entrustment scores significantly improved in the latter half of the academic year (38.2% to 80.1% highest scores).
  • Intraoperative entrustment was lowest for adrenal surgery (11.1%) compared to thyroid (37.0%) and parathyroid (39.4%).
  • Trainees achieved higher entrustment in preoperative (28.5%) and postoperative (53.5%) phases compared to intraoperative phases (23.6%).

Conclusions:

  • Entrustment scores demonstrate a learning curve, with significant improvement observed during the academic year.
  • Nonoperative phases of care (preoperative and postoperative) allow for earlier trainee entrustment compared to intraoperative skills.