Who Gets Feedback? Predictors of Receiving Narrative Feedback in Vascular Surgery Entrustable Professional Activities

Surgical residents and fellows require high-quality feedback to guide skill development. Entrustable professional activity (EPA) assessments allow for frequent feedback in all phases of care. However, feedback is optional. We sought to understand predictors of feedback provision in a national, multi-institutional study of EPA assessments.

EPA assessments were collected in the multi-institutional Vascular Surgery EPA Pilot in 2024. EPAs were rated on a scale of limited participation, direct supervision, indirect supervision and practice ready. Assessments included entrustment rating, postgraduate year (PGY), phase of care, and narrative feedback. Self-reported demographic information was collected. A mixed effects logistic regression was performed examining the effect of entrustment ratings, PGY, trainee and faculty gender and gender concordance, trainee underrepresented in medicine (URiM) identification, and phase of care on the probability of receiving narrative feedback.

In total, 1,998 assessments were collected across 19 institutions (n=17 residencies, n=13 fellowships). Faculty submitted 983 assessments with 759 (77%) containing feedback. 58% of trainees were men, 54% white, and 65% of faculty were men. Phase of care, post-graduate year, faculty gender, trainee gender, faculty-trainee gender concordance, and URiM-identification were not associated with likelihood of feedback. However, higher entrustment ratings were associated with lower odds of receiving feedback (OR 2.76 [95% CI: 1.25-6.10]).

In this national, multi-institutional study of vascular surgery EPA assessments, demographic characteristics were not associated with likelihood of receiving or giving feedback. However, higher performing trainees are less likely to receive feedback. This may limit high-performing trainees' ability to reach their full potential.