Surgical Competency Assessment Using Entrustable Professional Activities

Abstract

This year the American Board of Surgery (ABS) endorsed the use of entrustable professional activities (EPAs), a competencybased assessment tool, in all general surgery residencies. 1 This represents the next step in a visionary effort led by the ABS that engages all the major stakeholders in surgical education. A core group of dedicated educators developed individual EPAs and mapped them to specific behaviors linked to 5 levels of progressive entrustment of the individual resident. 2 Montgomery and associates 3 describe the results of a 2-year ABS EPA pilot study conducted in 28 volunteer residency programs. EPA microassessments were completed by faculty for residents during the course of clinical encounters and then reviewed by clinical competency committees (CCCs) at the conclusion of 6-month cycles; if the CCCs determined that enough information was available, they selected the entrustment level most closely corresponding to the preponderance of microassessments, along with an accompanying decision confidence level. They found that 17 565 CCC entrustment decisions were possible in 565 residents and almost three-fourths were made with moderate or high confidence. Confidence increased with increasing number of microassessments and with subsequent study cycles, suggesting that they became more comfortable with determining entrustability as experience with EPAs increased. The authors suggest that these data provide early validation for the use of EPAs and should help inform programs in the implementation stage.