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Can surgery fellows accurately self-assess their technical performance? Analysis of the Fellowship Council EPAs
Tom Farrell1, Boris Zevin2, Peter Szasz2
1Department of Surgery, Queen's University, 76 Stuart Street, Watkins 3A #4.3.103, Kingston, ON, K7L 2V7, Canada. Thomas.farrell@kingstonhsc.ca.
Background:
Self-assessment accuracy is crucial for self-improvement and continuing professional development, and is integral to formative evaluations in EPA-based surgical education. Accuracy of self-assessment among surgical trainees is mixed, and no studies have focused specifically on fellows completing EPA-based surgical training.
Methods:
A retrospective cohort study of clinical fellows completing an Advanced GI MIS & Bariatric Fellowships through the Fellowship Council in 2023-2024 was performed comparing self-assessment entrustment levels with those given by faculty (fellow-faculty dyads). The significance of the difference between dyads was tested using the Wilcoxon signed-rank test. Pearson correlation coefficient was used to assess association. A Generalized Estimating Equation was used to assess changes in accuracy for increasing caseloads and time. Dyads differing by two units or greater were assessed for case number and chronology.
Results:
45 fellows with a combined 584 dyads were analyzed. The mean EPA entrustment level provided by fellows was 2.98 ± 0.86, with a median = 3 [IQR 2-4], while the mean entrustment level from faculty was 3.28 ± 0.80, with a median = 3 [IQR 3-4]. The difference between fellow and faculty entrustment levels was statistically significant (Wilcoxon signed-rank test, z = 8.09, p < 0.001), proving fellow stringency, while there was a moderate, positive association between faculty and fellows, r(584) = .465, p < 0.001. Accuracy improved with both case load and time. Fellows only assigned themselves level 2 units or higher than faculty in 1.7% of encounters.
Conclusions:
Fellows in our study were accurate, though more stringent, self-assessors, with improvement of accuracy with case load and time. Fellows who overrate their performances may benefit from targeted interventions. Information gleaned through this study is crucial as we continue to operationalize CBME and to help with targeted education initiatives.
