Does PGY Level Equate Entrustment Level? Variability in Faculty Entrustment Ratings

Data regarding faculty behavior in selecting entrustment within the Entrustable Professional Activities (EPAs) framework is sparse. This study aimed to assess faculty variability in entrustment level ratings by general surgery resident postgraduate year (PGY).

Intra-operative EPA assessments were collected from November 2023 to October 2024 in a single institution. Junior residents were defined as PGY1-2, and senior residents as PGY3-5. EPA score variance was calculated for individual attending raters within resident PGY levels, excluding attendings with <5 assessments for a specific PGY level. Variability was compared using Levene's test and Bonferroni correction. Mean entrustment scores were compared using a linear mixed model with random effects.

A total of 1108 EPA assessments were collected from 52 different raters. Mean entrustment level increased with PGY (1 = 1.72; 2 = 1.93; 3 = 2.39; 4 = 2.87; 5 = 3.33, p < 0.001). PGY-1 s achieved entrustment of 1-2, while PGY-2 s achieved 1 to 3. Variability among these 2 groups was not significantly different (p > 0.05). Mean assessment levels for senior residents ranged from 2 to 4, and were not significantly different between groups (p > 0.05). Junior resident EPA ratings had statistically significantly lower entrustment (p < 0.01) and score variability than seniors (p < 0.01).

This analysis identified that most faculty demonstrate variability in the EPA scores assigned to residents within the same PGY level. Higher variance was observed from PGY3 to PGY5, suggesting individuals may enter training with similar skill levels, then develop operative skills at different rates.