Overcoming the Challenges of EPA Engagement: A Tool to Increase the Number of Submissions

To evaluate the impact of incorporating Entrustable Professional Activity (EPA) submission and completion statistics into weekly Morbidity and Mortality (M&M) Conferences on resident engagement and faculty participation in a high-volume surgical training environment.

This retrospective cohort study compares EPA submissions and completions before and after the intervention. Data were collected from weekly M&M reports, and analyses including descriptive statistics, Pearson's correlation, and chi-squared tests were completed to evaluate changes in submission and completion rates.

This study was conducted at Tulane University's general surgery residency program in New Orleans, LA. The main teaching sites are urban, tertiary care centers that function as safety net hospitals for the community.

All general surgery residents and teaching faculty involved in EPA assessments between July 2023 and December 2024 were included. Preintervention data were collected from July to December 2023, and postintervention data were collected from January to December 2024.

Following the intervention, mean weekly EPA submissions increased significantly from 8.1 to 21.0 (P < 0.001), and the proportion of EPA-eligible cases for which a micro-assessment was generated rose from 17.1% to 25.9% (P = 0.001). The mean number of completed EPA micro-assessments increased from 6.9 to 16.3 per week (P < 0.001), with completions among eligible cases rising from 14.6% to 20.1% (P = 0.01). EPA submissions correlated moderately with EPA-eligible case volume (r = 0.31). Variability in submission patterns and rates throughout the year suggests fluctuating engagement during the academic year.

Integrating EPA statistics into weekly M&M Conferences significantly increased EPA submission and completion rates without adding a substantial burden to the residents or faculty. This simple, scalable intervention effectively engages both residents and faculty with competency-based assessments. Future research should explore barriers to micro-assessment completion and use qualitative methods to understand fluctuating engagement.