Implementation of competence by design in Canadian neurosurgery residency programs*

Cadieux, Magalie; Healy, Michael; Cooke, Lara; Traeger, Lara; Kesselheim, Jennifer C.; Riva-Cambrin, Jay; Phitayakorn, Roy

doi:10.1080/0142159x.2021.1994937

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…12 EPAs are also part of Canada's Competence by Design training program across all specialties and levels, although specific information about content and implementation is limited. 13,14 This pilot of EPAs in general surgery programs across the United States is one of the first reports of large-scale implementation in US graduate medical education and the first in a procedural discipline. [15][16][17][18] It provides valuable information about the practical implementation of competency-based education as well as the performance of the general surgeryspecific EPAs.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of Entrustable Professional Activities in General Surgery

et al. 2023

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Objective: The ongoing complexity of general surgery training has led to increased focus on ensuring competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, ACGME Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country. The objective of this pilot study was to determine feasibility and utility of EPAs in general surgery resident training. Methods: 5 EPAs were chosen based on the most common procedures reported in ACGME case logs and by practicing general surgeons (right lower quadrant pain, biliary disease, inguinal hernia), along with common activities covering additional ACGME milestones (performing a consult, care of a trauma patient). Levels of entrustment assigned (1-5) were observation only, direct supervision, indirect supervision, unsupervised, and teach others. Participating site recruitment and faculty development occurred in 2017-2018. EPA implementation at individual residency programs began July 1, 2018 and was completed June 30, 2020. Each site was assigned 2 EPAs to implement and collected EPA microassessments on residents for those EPAs. The site clinical competency committees (CCC) used these microassessments to make summative entrustment decisions. Data submitted to the independent deidentified data repository every 6 months included the number of microassessments collected per resident per EPA and CCC summative entrustment decisions. Results: 28 sites were selected to participate in the program and represented geographic and size variability, community and university-based programs. Over the course of the 2-year pilot programs reported on 14 to 180 residents. Overall, 6,272 formative microassessments were collected (range, 0 to 1144 per site). Each resident had between 0 and 184 microassessments. The mean number of microassessments per resident was 5.6 (SD = 13.4) with a median of 1 (IQR = 6). There were 1,763 summative entrustment ratings assigned to 497 unique residents. Average number of observations for entrustment was 3.24 (SD 3.61) with a median of 2 (IQR 3). In general, PGY1 residents were entrusted at the level of direct supervision and PGY5 residents were entrusted at unsupervised practice or teaching others. For each EPA other than the consult EPA, degree of entrustment reported by the CCC increased by resident level. Conclusions: These data provide evidence that widespread implementation of EPAs across general surgery programs is possible, but variable. They provide meaningful data that graduating chief residents are entrusted by their faculty to perform without supervision for several common general surgical procedures and highlight areas to target for successful widespread implementation of EPAs.

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Section: Discussionmentioning

confidence: 99%

“…Similar to Halsted’s original concept, EPAs were imported from Europe and have been implemented across all specialties in the Netherlands 12 . EPAs are also part of Canada’s Competence by Design training program across all specialties and levels, although specific information about content and implementation is limited 13,14 …”

Section: Discussionmentioning

confidence: 99%

Implementation of Entrustable Professional Activities in General Surgery

et al. 2023

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“…Rather than using traditional surrogates of competency, such as case numbers and duration of training, learners progress through entrustable professional activities by demonstrating mastery of specific knowledge and skills . Such methods of assessment have already been adopted by the Royal College of Physicians and Surgeons of Canada and the American Board of Surgery to address the growing need of better preparing surgical residents . Entrustable professional activities have resulted in improved feedback for residents but require dedicated time, resources, and training to effectively implement …”

Section: Introductionmentioning

confidence: 99%

“…13,14 Such methods of assessment have already been adopted by the Royal College of Physicians and Surgeons of Canada and the American Board of Surgery to address the growing need of better preparing surgical residents. 11,15 Entrustable professional activities have resulted in improved feedback for residents but require dedicated time, resources, and training to effectively implement. 15 While entrustable professional activities provide a model for evidence-based assessment and learning, they remain dependent on discrete behaviors that can be broadly categorized into faculty entrustment and resident entrustablity.…”

mentioning

confidence: 99%

“…11,15 Entrustable professional activities have resulted in improved feedback for residents but require dedicated time, resources, and training to effectively implement. 15 While entrustable professional activities provide a model for evidence-based assessment and learning, they remain dependent on discrete behaviors that can be broadly categorized into faculty entrustment and resident entrustablity. 13,16,17 Faculty entrustment includes actions that impart trust and responsibility for patient care to residents while providing appropriate supervision, whereas resident entrustability includes behaviors and decision-making demonstrated by the trainee that warrant entrustment.…”

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confidence: 99%

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Faculty Entrustment and Resident Entrustability

Millar,

Matusko,

Evans

et al. 2024

JAMA Surg

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ImportanceAs the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs.ObjectiveTo assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs.Design, Setting, and ParticipantsThis cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level.Main Outcomes and MeasuresObserved resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients.ResultsA total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years’ experience: 67 [20.9%]; 6-14 years’ experience: 186 [58%]; ≥15 years’ experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P &lt; .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P &lt; .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions.Conclusions and RelevanceFaculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.

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