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

Training the next generation of pathologists is vital for high-quality clinical medicine. Competency-Based Medical Education (CBME) and accumulation of "Entrustable Professional Activities" (EPAs) are being implemented worldwide to standardize medical training in all specialties. However, CBME research specific to pathology is lacking. Surveys of training programs routinely using EPAs highlight challenges with administrative burden, completion rates, and feedback.

To investigate the impact of EPAs on workload and feedback in a pathology program after 5 years of implementation.

A cross-sectional survey was administered to residents in the Diagnostic and Molecular (Anatomical) Pathology program at the University of Toronto, which transitioned to an EPA-based CBME system in 2019.

The response rate was 83% (n = 25 of 30). More than half of responding residents submitted at least 4 EPAs per week (52%; n = 13), and most residents (76%; n = 19) estimated spending at least a half hour per week submitting and following up on EPAs. Most residents (92%; n = 23) disagreed with the statement that EPAs provided valuable feedback to their learning; however, all residents (100%; n = 25) agreed verbal feedback at sign-out was one of the most useful assessments of their abilities. Only a minority (36%; n = 9) regularly received verbal feedback alongside an EPA. Respondents overwhelmingly felt that EPAs had a negative effect on the rapport between staff and residents, and cited concerns about staff workloads.

This study is the first to quantify the workload associated with CBME in a pathology residency program and raises practical considerations for training programs considering implementation of EPAs.