Home Field Advantage? Comparing the Quality of EPA Observations Completed On- vs Off-Service

Background Increasing evidence suggests that supervisors exhibit different assessment behaviors for residents from their own discipline compared to those completing a rotation from another discipline. As programs of assessment rely on collecting robust performance data to inform high-stakes decisions about progress and promotion, it is important to examine the quality of such inputs. Objective To compare the quality of workplace-based assessments (WBAs) of emergency medicine (EM) residents by EM and non-EM assessors. Methods This retrospective database study compared the quality of WBAs using the Quality of Assessment of Learning (QuAL) score (range 0-5), a previously published measure of WBA quality that has demonstrated strong psychometric characteristics. Five entrustable professional activities (EPAs), 3 procedural and 2 non-procedural, mapped to both EM and non-EM rotations, were selected for inclusion. Two hundred and fifty WBAs (50 WBAs per EPA; 25 EM and 25 non-EM), completed from July 2019 to June 2021, were rated by 3 blinded EM physician raters. QuAL scores were analysed using factorial ANOVA. Results Mean QuAL scores for WBAs completed during EM rotations were significantly higher compared to those completed during non-EM rotations (3.66±0.99 vs 3.02±0.99). Further, mean QuAL score for procedural EPAs was significantly higher than non-procedural EPAs (3.61±1.00 vs 3.16±1.03). Conclusions In this study, the quality of WBAs completed for EM residents during non-EM rotations was of lower quality compared to assessments on EM rotations.