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MISSION: EPA Possible-Gamifying EPAs to Increase Engagement
Austin Dixon1, Caitlin Burnette1, Christopher R D'Adamo2
1Department of Surgery, Sinai Hospital, Baltimore, Maryland.
Objective:
General surgery residency programs have implemented entrustable professional activities (EPAs) into daily feedback, however, consistent engagement remains a challenge. This study aims to increase resident engagement EPAs with entrustable through a year-long, team competition designed to promote meaningful participation and sustained EPA use.
Design:
"MISSION: EPA Possible" is a point-based team competition rewarding residents for EPA completion, with extra points awarded for obtaining EPAs in areas historically lacking in engagement. An AI chatbot (Copilot) evaluates EPAs within the ABS app and calculates team scores using a predefined rubric. Residents are evenly divided into teams of four, each led by a resident EPA champion. Quarterly, the top team earns a $150 dinner while the top individual resident receives a half-day off clinical duty. All statistical analyses were conducted in SAS Version 9.4.1.
Setting:
One general surgery residency program during the 2025 to 2026 academic year.
Participants:
Clinical general surgery residents (n = 19 eligible, divided evenly into five study teams).
Results:
Total EPAs completed increased 12.3% in the first 9 blocks of AY25-26 compared to AY24-25. The average amount of EPAs collected per resident was 42.7, a 24% increase from 34.4 EPAs per resident preintervention. Residents rather than faculty initiated the majority of EPAs postintervention at 77% compared to 41% during AY24-25. Team success strongly correlated with EPA champion participation, with leaders of the top 5 teams completing 44, 31, 14, 24, and 3, respectively, during the first quarter. Net gain of 12 new attendings increased their number of EPAs completed, with 3 new attendings involved who had never collected an EPA preintervention.
Conclusions:
Gamifying EPAs through a team-based competition is an effective, low-cost method tailorable to any program looking to improve or maintain EPA engagement.
Mission:
EPA Possible highlights that leveraging competition, peer leadership, and targeted incentives can effectively promote resident ownership.
