The Feasibility and Utility of Vascular Surgery Entrustable Professional Activities: A Multi-InstitutionalPilot Study
Thomas Serena1, M Libby Weaver2, Ting Sun2
1Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, West Virginia.
Objective:
Entrustable professional activities (EPAs) have been embraced by the medical education community as a framework to guide competency-based education systems. The Vascular Surgery Board and Association for Program Directors in Vascular Surgery collaborated on the development of 15 vascular surgery EPAs, covering the core clinical activities of a vascular surgeon. We sought to explore engagement and perceptions of feasibility and utility of EPA assessment implementation for participants in a national, multi-institutional pilot.
Design:
Faculty assessment and trainee self-assessment of 15 vascular surgery EPAs were rated on a 4-point entrustment scale: 1 = limited participation, 2 = direct supervision, 3 = indirect supervision, and 4 = practice-ready, with accompanying behavioral anchors describing the actions expected of a learner at each level. Following an introductory webinar, the American Board of Surgery EPA Application assessment tool (delivered via SIMPL) was provided to all participating programs. Surveys evaluating the perceived feasibility and utility of the EPAs were developed. The surveys were distributed to pilot participants via email in June 2024 and responses were collected using Qualtrics. For Likert-scale items, descriptive statistics were calculated. For open-ended responses, thematic analysis was conducted to explore perceptions of respondents. This retrospective cohort study received an exemption determination from the University of Utah Institutional Review Board prior to the initiation of study procedures.
Setting:
This was a national, multi-institutional study. Participating programs included both academic, community, and hybrid programs.
Participants:
Thirty institutions (22 fellowship, 27 residency programs) participated in the pilot. Post-pilot surveys were completed by 89 participants, including 22 program directors (Response rate 73%), 13 program managers (Response rate 43%), 26 trainees, and 28 faculty.
Results:
A total of 2746 EPA assessments were completed by faculty and trainees during the pilot. Regarding ease of integration of EPA assessments into perioperative workflow, 92% of trainees and 96% of faculty had neutral or positive responses. Eight four percent of trainees agreed that they were comfortable initiating EPA assessments. Seventy seven percent of trainees felt that EPA data would help them to set learning goals and 77% felt that EPA assessments helped them identify areas for improvement. For faculty, 74% felt the EPA assessments helped them identify topics on which to provide feedback.
Conclusions:
This study demonstrates the feasibility and utility of EPA workplace-based assessment implementation at a diverse subset of vascular surgery training programs. Integration into usual clinical workflow was viewed as easy by both faculty and trainees. Furthermore, trainees felt the assessments were helpful to their learning, and faculty felt the assessment anchors helped them give meaningful feedback to trainees. These findings support an overall positive reception to EPA assessments in vascular surgery.
