EPAs Have Entered the Room: An Analysis of Residents' and Faculty Members' Perceptions

Entrustable professional activities (EPAs) have emerged as a method of competency-based assessment in general surgery residency programs. While EPAs complement competency and milestone assessments, identifying practical considerations for faculty and resident participation is needed to secure buy-in of the framework. This study aims to determine facilitators and barriers cited by trainees and faculty members to using the general surgery EPAs.

Sixteen semi-structured interviews were conducted with 8 residents and 8 faculty members at a general surgery program to assess barriers, concerns, experiences, quality, and quantity of feedback. Transcripts were analyzed inductively guided by grounded theory analysis.

Faculty had an overall positive perception about EPAs and felt well-informed about the method. They perceived EPAs provided more granular data about trainees' performance compared to traditional feedback and move surgery toward higher quality training. Faculty did not believe EPAs impacted their relationships with or mentorship of trainees. The most cited faculty pitfalls were forgetfulness and lack of time to complete evaluations. Residents cited that EPAs provide more and higher-quality narrative feedback and more frequent assessments, and that faculty buy-in is building. Residents expressed frustration that EPAs do not cover all their activities and were concerned about potential negative repercussions including delaying graduation and career progression.

Compared to traditional feedback, faculty had an overall positive impression of EPA assessments. Resident physicians reported more frequent and detailed feedback while fearing the potential implications of this method on their ability to graduate and succeed as practicing general surgeons. Buy-in may be increased through workflows that foster EPA completion and updated messaging on how EPAs will be used for certification.