Entrustable Professional Activities Beyond Engagement: Best Practices From Across the Training Continuum

To move toward competency-based education, the American Board of Surgery (ABS) has embraced an assessment framework based on entrustable professional activities (EPAs). Eighteen general surgery EPAs were launched in July 2023 for use in all US surgical residency programs. The first year involved progressive engagement with the goal of establishing an assessment collection method and beginning data collection by the end of the year. Those general surgery graduates wishing to sit for their American Board of Surgery qualifying examination starting in 2028 will need to submit a composite profile of their EPA assessments.

After nearly 2 y of the EPA-based assessments in general surgery residencies, there have been hundreds of thousands of assessments collected, yet there remains variability in performance across programs. There are a multitude of reasons for variable performance related to local factors such as program resources and structure. However, important challenges exist such as consistent engagement from faculty and trainees. Ongoing EPA implementation efforts are necessary to maximize the benefit for trainees, faculty, program, and departmental leadership.

Implementation of EPAs is impacted by local program factors such as structure, resources, and practice patterns. Engagement with EPA assessments requires program leadership support to drive culture change. This manuscript discusses tools to generate buy-in and optimize feedback from the resident and faculty perspective, advice for program leadership to increase engagement among their trainees and faculty, and examples of how departmental leadership can motivate engagement and strategically leverage EPA data.