Core Entrustable Professional Activities for Urology: A National Delphi Study of Academic Urology Educators

To establish a consensus-based foundation for Entrustable Professional Activities (EPAs) in urology by identifying core urology EPAs - activities that all residents should be able to perform independently upon graduation. EPAs are a competency-based assessment framework designed help graduate medical training programs assess trainee readiness for independent practice. Although several specialties have formally incorporated EPAs into their training and certification frameworks, adoption within urology has been limited.

A comprehensive list of EPAs spanning the breadth of urology practice was reviewed by a panel of academic urologists. Core EPAs for urology were identified through a three-round modified Delphi process. These were reviewed by EPA experts and consolidated into a smaller set of combined urology EPAs suitable for pilot testing and implementation. The quality of the final EPAs was assessed using EQual - an EPA rating rubric with strong validity evidence.

Out of a total of 242 candidate EPAs, 144 core EPAs were identified. Core designation was achieved for 100% of EPAs for initial evaluation of urologic conditions, 89% of EPAs covering medical/non-surgical management, and 33% of EPAs describing operations/procedures. Expert review, consolidation, and revision resulted in a final set of 15 urology EPAs. Average EQual rating was 4.8±0.42 (out of 5), indicating a high level of quality.

We identified 15 EPAs representing the core professional activities of urology. These findings suggest that graduating urology residents are expected to independently evaluate and medically manage most urologic conditions, while performing a more limited range of urologic procedures.