Competency-Based Cardiology Training: A Simple Approach to Improve Supervisor Completion of Entrustable Professional...

Adult cardiology residency programs formally transitioned to Competency by Design (CBD) in July 2021. CBD was designed to establish clear learning expectations and increase opportunities for coaching; however, cited challenges include inconsistent participation by staff, and variable timelines for receiving feedback. This project was designed to implement a simple intervention to improve expiry rates and completion timelines of entrustable professional activities (EPAs).

EPAs triggered by cardiology residents at Dalhousie University between July 1, 2020 and February 28, 2023 were reviewed. The intervention consisted of performance reviews, including a grand rounds presentation, along with a personalized data set distributed to each staff supervisor, with individual statistics compared to group averages. Outcomes include EPAs completed per resident-months, time to completion, and percentage of expired EPAs.

At 12 months postintervention, the percentage of expired EPAs decreased from 35.0% to 21.5% (odds ratio 0.51, CI 0.33-0.79; P = 0.03), and the time to completion decreased from 7.3 ± 5.99 days to 5.0 ± 5.78 days (difference -2.31, CI -3.55 to -1.07; P < 0.001). The number of EPAs completed per resident-months increased from 3.10 to 4.29 (rate difference 1.18; CI 0.64-1.72; P < 0.001), and the percentage of EPAs completed within the target time of 48 hours increased from 54.4% to 71.5% (OR 2.11, CI 1.27-3.50; P = 0.004).

Performance reviews in the form of a group presentation, along with the distribution of personalized data sets to supervisors, positively impacted EPA expiry rates, completion timelines, and completion rates, which helped facilitate the transition to CBD.