Understanding Entrustable Professional Activity Micro-assessment Quality and Entrustability: Impact of Gender and...

In recent years, US surgical residency programs have instituted the American Board of Surgery's Entrustable Professional Activity (EPA) micro-assessments of resident performance. Early studies demonstrate that factors like gender may impact scoring and quality, but there is lack of insight into specific contributory elements. We sought to describe our residency's initial experience implementing EPAs, examining underlying factors influencing evaluation patterns relating to entrustability ratings and feedback quality.

This retrospective study analyzed anonymized EPA micro-assessments from June 7, 2023, to March 12, 2024. Attending-written evaluations received an agreed-upon quality (QuAL) rating score by two assessors. The relationship between micro-assessment entrustability/quality scores and attending/resident factors was studied using univariate and multivariable analyses.

A total of n = 2496 attending and resident assessments were obtained from 56 residents (62.5% female, 37.5% male) and 79 attendings (34.2% female, 65.8% male). Female faculty were overall in practice fewer years than the male attendings. Residents self-rated their entrustability higher (17.0%), similarly (56.0%), and lower (27.0%) than attendings. Female residents more commonly underestimated their entrustability (P < 0.01) and received longer feedback with more suggestions and connections between suggestions and behavior (P < 0.01). Female faculty wrote longer, high-quality evaluations with more suggestions (P < 0.01). With increasing years in practice of >5 y, attendings rated resident entrustability progressively lower (P < 0.01).

Our findings identify gender and experience level as underlying factors impacting resident entrustability scores and quality of attending EPA evaluations after accounting for EPA encounter type and attending specialties. Residency programs should note these trends and potential biases as the surgical community progressively integrates these micro-assessments.