Shared EPA Expectations: Mapping Micro-Assessments to The Traditional Rotational Training Framework

In the transition to competency-based surgical training, Entrustable Professional Activities (EPAs) must demonstrate their efficacy as a formative assessment tool while working in a time-based, rotational framework. We seek to identify how the EPA clinical content areas fit into a traditional time-based general surgery training paradigm at a single institution to explore how to bolster EPA implementation.

The educational lead faculty for each resident rotation were asked how often the residents on that rotation would perform each of the EPAs in all phases of care within a 1-month block. Residents received rotation-specific surveys over a 6-month period on how often they performed the EPA functions in a month's rotation. The frequency of reported EPA exposure was then mapped to our clinical year-specific training schedule and intraclass correlation coefficients were calculated to determine attending and resident agreement.

Twenty faculty completed the survey across our 4 hospital sites and 45 rotations. There were 91 resident responses over 6 months for 41 individual rotations. When averaged together, the most frequent EPA opportunity for each of the 5 clinical years of training was Consults (EPA 7). Trends in EPA opportunities were identified based on clinical year and phase. Overall, the interclass correlation coefficient (ICC) values were poor, suggesting a low level of agreement between faculty and residents. Our institution's rotation-specific EPA roadmap provides a projection of where the EPA clinical areas fit into this time-based training program.

A thorough survey-based review of the EPA content areas' alignment with a single institution's rotation structure highlights areas of low frequency and agreement of EPA task performance. The results of this study will help to guide EPA implementation through the intentional creation of shared EPA expectations.