Entrustable Professional Activities (EPAs) in General Surgery-From Inception to Implementation: A Scoping Review

To review the conceptualization, development, implementation, and evaluation of entrustable professional activities (EPAs) in general surgery training and to identify gaps in existing literature.

The coping review follows the preferred reporting items for systematic reviews and meta-analysis protocols extension for scoping reviews guidelines. The authors systematically searched PubMed, Scopus, Embase, and Web of Science from database inception to November 2025. Inclusion criteria consisted of original research, observational studies, commentaries, and letters addressing EPAs in general surgery. The authors excluded articles focused on undergraduate medical education, non-English articles, and review articles.

Eighty-two studies met inclusion criteria. EPAs have progressed from a conceptual framework to successful multiprogram national implementation. The American Board of Surgery pilot yielded over 6,000 microassessments, demonstrating feasibility and confirming progressive entrustment aligned with resident seniority. Multi-institutional quality improvement initiatives achieved high completion rates (80.8%) and a 99.6% practice-ready rate among senior residents. Strong correlations between EPA scores and Accreditation Council for Graduate Medical Education (ACGME) milestones provided validity evidence. However, considerable heterogeneity exists in EPA definitions across studies. Faculty-resident perception gaps persist, with faculty rating entrustment lower than resident self-assessments. Implementation challenges include high operational burden, inconsistent documentation, and cost considerations. Validity evidence remains early-phase, with limited linkage to patient outcomes.

EPAs in general surgery have progressed from inception to widespread implementation; however, critical gaps persist in consistent validation, contextual embedding, bias mitigation, and robust linkage to surgical outcomes. Future work should focus on standardized definitions, theory-driven validity frameworks, and outcome-linked evaluations.