Entrustable Professional Activities in Surgery

Abstract

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.

WITHDRAWN: ChatGPT-4 as a Board-Certified Surgeon: A Pilot Study

“…The MAMSEs evaluated ChatGPT’s clinical decision-making skills on four mock clinical case scenarios with topics that were randomly selected from the ABS’s Entrustable Professional Activities (EPA) topic list: acute abdomen, gallbladder disease, right lower quadrant pain and appendicitis, and benign and malignant breast disease. The EPA project, announced by the ABS in 2022, redefined the learning objectives of contemporary graduate surgical education and aims to steer the certification standards of general surgery residents in the United States toward a competency-based assessment paradigm [13]. Competencies are defined as abilities that blend knowledge, skills, values, and attitudes, and the EPAs are an assessment framework and tool used to evaluate competency [13].…”

“…The EPA project, announced by the ABS in 2022, redefined the learning objectives of contemporary graduate surgical education and aims to steer the certification standards of general surgery residents in the United States toward a competency-based assessment paradigm [13]. Competencies are defined as abilities that blend knowledge, skills, values, and attitudes, and the EPAs are an assessment framework and tool used to evaluate competency [13]. A resident is deemed ready for independent practice when faculty members consistently assess them as capable of safely executing EPA-specific learning objectives without supervision.…”