Entrustable Professional Activities: Do General Surgery Residents Trust Them?

Gupta, Aakanksha; Watkins, Anthony C.; Fahey, Thomas J.; Barie, Philip S.; Narayan, Mayur

doi:10.1016/j.jsurg.2019.12.005

Cited by 13 publications

(7 citation statements)

References 15 publications

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“…30 Reciprocal trust of learners in their supervisors may facilitate self-directed learning. 27,31 While longer relationships presumably enable more valid entrustment decisions, 21,32 and short rotations may hamper their validity, 33 the dynamics in supervisory relationships and their effects on entrustment decisions have not been studied extensively. Qualitative research methods, possibly supported by artificial intelligence techniques such as using natural language processing to analyze feedback statements, 34 may shed light on how trusting relationships build and how these affect the quality of entrustment decisions, both over time with less intensity and in short but intensive collaborations.…”

Section: Understanding the Conditions For Rich Entrustment Decisionsmentioning

confidence: 99%

Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade

et al. 2021

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To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.

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Section: Understanding the Conditions For Rich Entrustment Decisionsmentioning

confidence: 99%

Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade

et al. 2021

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“…Another significant issue is that several physicians raised concerns about the fairness of EPAs. When EPAs are deployed as measurements of performance and eligibility for promotion or graduation, the fairness of the system needs to be heavily scrutinized[ 34 ]. In one study, surgery resident self-evaluations agreed more strongly with surgery faculty assessments than with emergency medicine faculty assessments, highlighting the importance of choosing suitable evaluators[ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…First, the acceptability of various medical systems to EPAs, as well as the costs of EPAs, are always enormous, and both may be prohibitive in terms of time and economic burden. There is a need for increased faculty development on how to use the tools during the process [ 24 , 34 , 37 ]. For certain developing countries, such as India, there was a severe scarcity of manpower and resources, and management had to pay close attention to actual conditions[ 31 ].…”

Section: Resultsmentioning

confidence: 99%

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An update on current EPAs in graduate medical education: A scoping review

Liu

Jiang

et al. 2021

Medical Education Online

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The purpose of this scoping review is to update the recent progress of EPAs research in GME, focusing on the topical concern of EPAs effectiveness, and to provide a reference for medical researchers in countries/regions interested in introducing EPAs. Guided by Arksey and O’Malley’s framework regarding scoping reviews, the researchers, in January 2021, conducted a search in five databases to ensure the comprehensiveness of the literature. After the predetermined process, 29 articles in total were included in this study. The most common areas for the implementation and evaluation of EPAs were Surgery (n = 7,24.1%), Pediatric (n = 5,17.2%) and Internal medicine (n = 4,13.8%), a result that shows a relatively large change in the research trend of EPAs in the last two years. Prior to 2018, EPAs research focused on internal medicine, psychiatry, family medicine, and primary care. The articles in the category of EPAs implementation and evaluation had four main themes: (1) validation of EPAs (n = 16,55.2%); (2) describing the experience of implementing EPAs (n = 11,37.9%); (3) examining the factors and barriers that influence the implementation and evaluation of EPAs (n = 6,20.6%); and (4) researching the experiences of faculty, interns, and other relevant personnel in using EPAs. Training programs were the most common EPAs implementation setting (n = 26,89.6%); direct observation and evaluation (n = 12,41.4%), and evaluation by scoring reports (n = 5,17.2%) were the two most common means of assessing physicians’ EPA levels; 19 papers (65.5%) used faculty evaluation, and nine of these papers also used self-assessment (31.0%); the most frequently used tools in the evaluation of EPAs were mainly researcher-made instruments (n = 37.9%), assessment form (n = 7,24.1%), and mobile application (n = 6,20.7%). Although EPAs occupy an increasingly important place in international medical education, this study concludes that the implementation and diffusion of EPAs on a larger scale is still difficult.

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“…These findings were consistent with operative performance rating (OPR) studies, which emphasized the importance of immediate rating completion, noting a significant decrease in feedback clarity and specificity at more than 3 days after observation . Further insights from EPA implementation across different residency programs will be needed to help address any ongoing resident concerns about how EPAs are being used, as described by Gupta et al from a survey of resident perceptions of pilot EPAs. Practical guidance for faculty about expected frequency of EPA microassessments completed per resident or per time period will likely be dictated by program-specific expectations, but assessment data collected over these initial years of EPA implementation may help clarify best practices for the future.…”

Section: Practical Considerations For Epa Implementationmentioning

confidence: 99%

Entrustable Professional Activities in Surgery

Montgomery,

Mellinger,

Lindeman

2024

JAMA Surg

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ImportanceEntrustable professional activities (EPAs) compose a competency-based education (CBE) assessment framework that has been increasingly adopted across medical specialties as a workplace-based assessment tool. EPAs focus on directly observed behaviors to determine the level of entrustment a trainee has for a given activity of that specialty. In this narrative review, we highlight the rationale for EPAs in general surgery, describe current evidence supporting their use, and outline some of the practical considerations for EPAs among residency programs, faculty, and trainees.ObservationsAn expanding evidence base for EPAs in general surgery has provided moderate validity evidence for their use as well as practical recommendations for implementation across residency programs. Challenges to EPA use include garnering buy-in from individual faculty and residents to complete EPA microassessments and engage in timely, specific feedback after a case or clinical encounter. When successfully integrated into a program’s workflow, EPAs can provide a more accurate picture of residents’ competence for a fundamental surgical task or activity compared with other assessment methods.Conclusions and RelevanceEPAs represent the next significant shift in the evaluation of general surgery residents as part of the overarching progression toward CBE among all US residency programs. While pragmatic challenges to the implementation of EPAs remain, the best practices from EPA and other CBE assessment literature summarized in this review may assist individuals and programs in implementing EPAs. As EPAs become more widely used in general surgery resident training, further analysis of barriers and facilitators to successful and sustainable EPA implementation will be needed to continue to optimize and advance this new assessment framework.

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Entrustable Professional Activities: Do General Surgery Residents Trust Them?

Cited by 13 publications

References 15 publications

Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade

Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade

An update on current EPAs in graduate medical education: A scoping review

Entrustable Professional Activities in Surgery

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