Experience With EPAs During the Year of Progressive Engagement

Assessment of general surgery residents using Entrustable Professional Activities began in July, 2023 in anticipation of requirements for those applying for admissibility to the American Board of Surgery in 2028. We describe the initial experience across all general surgery programs using the American Board of Surgery platform to submit EPA microassessments during the first year of engagement.

EPA microassessments for general surgery residents were submitted throughout the year by residents and faculty on a secure platform. At year end these data were downloaded and deidentified with respect to program, faculty, and resident. Microassessment data from all platforms was included in the overall counts, while analyses were restricted to microassessments from the ABS app completed by faculty. Descriptive statistics were utilized to summarize engagement levels across programs and EPA topics, and mean entrustment levels were compared across PGY levels to identify trends.

134,894 microassessments were submitted from 349 programs across all platforms. 114,306 were from 330 programs using the ABS app. There was progressive engagement throughout the year. 55,445 microassessments were completed by faculty and 58,861 by residents. Mean number of EPAs per resident was 9.25 (s.d.12.33). Mean number of EPAs completed by residents was 11.54 (s.d.17.78). The number of microassessments by institution ranged from 1 to 1525 (mean 168, s.d. 228). The number of microassessments by faculty was relatively equally distributed across PGY year (14,112 PGY1, 10,745 PGY2, 11,235 PGY3, 9,623 PGY4, 9,730 PGY5). Microassessments were not equally distributed by EPA, with the fewest for severe pancreatitis (131) and the most for gallbladder disease (10,770). 69% of assessments were from the intraoperative phase, 8% were procedural, and 23% nonoperative. Mean entrustment level for the formative microassessments increased for all EPAs and in all phases with increasing PGY year.

The first year of EPA implementation demonstrates broad uptake of EPA assessments in most general surgery programs and across all levels of training. The data highlight opportunities for increasing EPA use while suggesting the value of these workplace-based assessments to program directors and trainees.