Structural imbalances in EPA Perceptions: A multi-center study of cognitive differences between faculty and trainees...

This study aimed to identify and quantify systematic cognitive differences between clinical faculty and surgical residents regarding core competency requirements in standardized residency training, using the Entrustable Professional Activities (EPA) framework, and to provide evidence for optimizing competency-based training curricula.

A multicenter cross-sectional anonymous online questionnaire survey was administered in March 2025 to 42 supervising faculty and 68 surgical residents across three training bases in Guizhou Province. The questionnaire was developed in accordance with the 2022 Edition of the National Standards and Contents for Residency Training in China, covering 100 EPA items across five subspecialties: neurosurgery, general surgery, urology, orthopedics, and anesthesiology. Participants rated the importance and necessity of each item using a 4-point Likert scale. Reliability was evaluated using Cronbach's α and intraclass correlation coefficient (ICC). Group differences were analyzed via independent-samples Mann-Whitney U tests, with Cohen's d for effect size, and inter-rater consistency was assessed using Kendall's W.

A total of 110 valid questionnaires were recovered (valid response rate: 93.2%). The overall Cronbach's α was 0.951, and the test-retest ICC was 0.89, indicating excellent reliability. High consistency (> 90%) was observed between faculty and residents for general surgery and neurosurgery EPAs. Among 19 orthopedic EPAs, 10 items showed significant differences (P < 0.05), with Cohen's d ranging from 0.82 to 1.55; residents consistently rated these items higher than faculty. For three anesthesiology items related to "Life Monitoring and Resuscitation," faculty scored a mean of 4.00 ± 0, whereas residents scored 3.36 ± 1.03 (d = 0.98, P < 0.01). Kendall's W ranged from 0.10 to 0.17, indicating weak overall consistency. Both groups emphasized strengthening training in soft skills, including medical documentation and physician-patient communication.

Systematic discrepancies exist between faculty and residents in perceptions of orthopedic procedural skills and anesthetic safety during surgical residency. To address this gap, unified entrustment benchmarks, integrated assessable soft-skill training, and continuous formative feedback should be prioritized to improve competency-based surgical residency education.