Impact of Entrustable Professional Activities on Workload and Education in a Canadian Pathology Residency Program

Area of Science:

• Medical Education
• Pathology Training
• Competency-Based Medical Education

Background:

• Competency-Based Medical Education (CBME) and Entrustable Professional Activities (EPAs) are global standards for medical training.
• Pathology-specific research on CBME implementation and its impact is limited.
• Existing surveys indicate challenges with administrative burden, completion rates, and feedback in EPA-based training.

Purpose of the Study:

• To investigate the impact of Entrustable Professional Activities (EPAs) on workload and feedback within a pathology residency program.
• To evaluate the effectiveness of an EPA-based Competency-Based Medical Education (CBME) system after five years of implementation.

Main Methods:

• A cross-sectional survey was conducted among residents in the Diagnostic and Molecular (Anatomical) Pathology program at the University of Toronto.
• The program transitioned to an EPA-based CBME system in 2019.
• The survey assessed resident perceptions of workload, feedback quality, and overall impact of EPAs.

Main Results:

• A high response rate of 83% (n=25) was achieved.
• Over half of residents (52%) submitted at least 4 EPAs weekly, with 76% spending over 30 minutes weekly on EPA-related tasks.
• Most residents (92%) found EPAs provided little learning feedback, preferring verbal feedback during sign-out (100%), which was infrequently paired with EPAs (36%).
• Residents reported negative impacts on staff-resident rapport and concerns regarding increased staff workload.

Conclusions:

• This study quantifies the workload associated with CBME in pathology residency.
• The findings highlight practical challenges and considerations for pathology programs implementing EPA-based training.
• Alternative or supplementary feedback mechanisms may be needed to enhance the value of EPAs in pathology education.