Implementation of entrustable professional activities into fellowship council accredited programs: a pilot project

Abstract

Objective The Fellowship Council (FC) is transitioning to a competency-based medical education (CBME) model, including the introduction of Entrustable Professional Activities (EPAs) for training and assessment of Fellows. This study describes the implementation process employed by the FC during a ten-month pilot project and presents data regarding feasibility and perceived value. Methods The FC coordinated the development of EPAs in collaboration with the sponsoring societies for Advanced GI/MIS, Bariatrics, Foregut, Endoscopy and Hepatopancreaticobiliary (HPB) fellowships encompassing the preoperative, intraoperative, and postoperative phases of care for key competencies. Fifteen accredited fellowship programs participated in this project. The assessments were collected through a unique platform on the FC website. Programs were asked to convene a Clinical Competency Committee (CCC) on a quarterly basis. The pilot group met monthly to support and improve the process. An exit survey evaluated the perceived value of EPAs. Results The 15 participating programs included 18 fellows and 106 faculty. A total of 655 assessments were initiated with 429 (65%) completed. The average (SD) number of EPAs completed for each fellow was 24(18); range 0–72. Intraoperative EPAs were preferentially completed (71%). The average(SD) time for both the fellow and faculty to complete an EPA was 27(78) hours. Engagement increased from 39% of fellows completing at least one EPA in September to 72% in December and declining to 50% in May. Entrustment level increased from 6% of EPAs evaluated as “Practice Ready” in September to 75% in June. The exit survey was returned by 63% of faculty and 72% of fellows. Overall, 46% of fellows and 74% of program directors recommended full-scale implementation of the EPA framework. Conclusion A competency-based assessment framework was developed by the FC and piloted in several programs. Participation was variable and required ongoing strategies to address barriers. The pilot project has prepared the FC to introduce CBME across all FC training programs. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09502-5.

Entrustable Professional Activities in Surgery

“…With similar challenges in resident and fellow preparedness being discussed in the vascular surgery education community, a move toward a CBE model has also been ongoing, including study of OPR assessments using the SIMPL-OR app as well as EPA development through the ABS . Other EPA development projects reported in the surgical education literature include multiple subspecialties within the Fellowship Council for their accredited gastrointestinal surgery fellowships, including EPAs for abdominal wall, bariatric, foregut, and hepatobiliary surgery as well as for flexible endoscopy …”

“…Created in collaboration with relevant society groups, these Fellowship Council EPAs can be customized based on the subtype of gastrointestinal surgery fellowship, with topics that move beyond core general surgery residency EPAs to more advanced activities that a fellowship-trained surgeon would be expected to manage (eg, “Evaluate and manage patients with parastomal hernias,” “Evaluate and manage patients with esophageal motility disorders”) . Other general surgery subspecialty fellowship EPAs under development or planned for future development include endocrine surgery (led by the American Association of Endocrine Surgeons), complex general surgical oncology (ABS), pediatric surgery (ABS), and trauma, burn, and surgical critical care (ABS) fellowships.…”