The surgical consult entrustable professional activity (EPA): Defining competence as a basis for evaluation

Stucke, Ryland S.; Sorensen, Meredith J.; Rosser, Alexandra A.; Sullivan, Sarah

doi:10.1016/j.amjsurg.2018.12.056

Cited by 17 publications

(16 citation statements)

References 22 publications

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“…It was also found that most evaluators usually agree on resident performance but disagree on the interpretation of the tools used to assess them (ie, number scores) 32. This study and others reveal the need for significant faculty development to mitigate inherent biases and the need for multiple assessment tools 28,29,32…”

Section: Operationalizing Cbe With Entrustable Professional Activitiesmentioning

confidence: 71%

“…A crucial advantage to EPAs is providing residents with progressive independence before graduation while in a safe and supervised learning environment, rather than waiting until the trainee enters independent practice. 29,30 This model creates a foundation that instills confidence in both the educators and trainees. 31 A major obstacle to adopting this evaluation approach is the implicit biases among evaluators.…”

Section: Operationalizing Cbe With Entrustable Professional Activitiesmentioning

confidence: 99%

“…A major obstacle to adopting this evaluation approach is the implicit biases among evaluators. In a prospective study, EPAs were used to assess residents performing a surgical consult 29. Faculty presented biases when evaluating certain residents based on factors related to clinical rapport, seniority of residents, reputation of residents, prior performance, and expectation of resident performance.…”

Section: Operationalizing Cbe With Entrustable Professional Activitiesmentioning

confidence: 99%

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Competency-Based Education: Will This be the New Training Paradigm in Plastic Surgery?

Reddy

Applebaum

Gosain

2022

Journal of Craniofacial Surgery

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The Accreditation Council for Graduate Medical Education created the “Next Accreditation System” in 2013 requiring residents to meet educational milestones based on core competencies over the course of their training. The 6 core competencies include patient care and technical skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Since the traditional time-based model requires a predetermined length of training irrespective of learning style, pace, or activity, a competency-based model is appealing because it refocuses education on deliberate and relevant skills acquisition and retention. Plastic surgery has been slowly transitioning to competency-based education (CBE), thereby permitting residents to learn at their own pace to master each competency. We performed a nonsystematic literature review of the efficacy of CBE and implementation efforts, particularly within plastic surgery. The literature revealed perceived barriers to implementation, as well as the nuts and bolts of implementation. We highlighted possible solutions and training tools with practical applications in plastic surgery. Success of CBE in plastic surgery requires instituting a transparent process that involves continuously piloting multiple assessment tools and a discussion of related costs. CBE may be particularly appealing for trainees focused on further training in craniofacial or pediatric plastic surgery after completion of an integrated or independent training program in plastic surgery to allow them to focus on their career interests once competence is achieved in the core skills required of a plastic surgeon.

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Section: Operationalizing Cbe With Entrustable Professional Activitiesmentioning

confidence: 71%

Section: Operationalizing Cbe With Entrustable Professional Activitiesmentioning

confidence: 99%

Section: Operationalizing Cbe With Entrustable Professional Activitiesmentioning

confidence: 99%

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Competency-Based Education: Will This be the New Training Paradigm in Plastic Surgery?

Reddy

Applebaum

Gosain

2022

Journal of Craniofacial Surgery

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“…Este consenso identifica cuatro actividades principales que describen un amplio ámbito de ejercicio profesional del cirujano general colombiano, dirigidas a varios grupos de pacientes, en diferentes contextos y situaciones de práctica. Estos hallazgos se suman al reciente debate sobre el rol de las APC en cirugía, originado en los Países Bajos, que constituye el centro de la educación quirúrgica contemporánea, y en especial en Norte América [5][6][7][8] . Esta conversación académica, sin embargo, es limitada aún en América Latina.…”

Section: Discussionunclassified

“…La formación de cirujanos generales en el mundo no es ajena a esta transformación. La adopción de marcos de EBC en cirugía es, hoy en día, una realidad en diversos países europeos y norteamericanos [5][6][7][8] . Frente a los desafíos crecientes en materia de seguridad y cuidado del paciente, durante la ultima década, varias universidades y programas de cirugía han iniciado profundas transformaciones en sus currículos para responder a las expectativas de la sociedad.…”

Section: Introductionunclassified

Fundamentos para un currículo nacional en Cirugía General basado en competencia: Consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía

et al. 2021

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Frente a los desafíos de la Educación Basada en Competencia, este consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía informa sobre las mínimas competencias profesionales esperadas del cirujano egresado de los veinte programas de Especialización en Cirugía General en Colombia. Un total de 105 profesores de los programas de especialización evaluaron tres áreas de competencia profesional: 1) atributos profesionales generales del residente durante su formación, 2) competencias prácticas (procedimientos quirúrgicos) que los residentes deben realizar al final de su entrenamiento y 3) Actividades Profesionales Confiables (APC) que los residentes deben ejecutar sin supervisión al final de su entrenamiento. Los resultados informan un alto nivel de consenso en el 100 % los atributos profesionales generales y APC, y del 75 % en diferentes procedimientos quirúrgicos. El consenso abre la puerta para el desarrollo de un currículo nacional de la especialidad y tiene implicaciones para la práctica educativa e investigación futura.

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Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities

Montgomery,

Mellinger,

McLeod

et al. 2024

JAMA Surg

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ImportanceA competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs’ clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known.ObjectiveTo identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions.Design, Setting, and ParticipantsThis cohort study used deidentified data from the EPA Pilot Study, with participating sites at 28 general surgery residency programs, prospectively collected from July 1, 2018, to June 30, 2020. Data were analyzed from September 27, 2022, to February 15, 2023.ExposureMicroassessments of resident entrustment for pilot EPAs (gallbladder disease, inguinal hernia, right lower quadrant pain, trauma, and consultation) collected within the course of routine clinical care across four 6-month study cycles. Summative entrustment ratings were then determined by program CCCs for each study cycle.Main Outcomes and MeasuresThe primary outcome was CCC decision-making confidence rating (high, moderate, slight, or no confidence) for summative entrustment decisions, with a secondary outcome of number of EPA microassessments received per summative entrustment decision. Bivariate tests and mixed-effects regression modeling were used to evaluate factors associated with CCC confidence.ResultsAmong 565 residents receiving at least 1 EPA microassessment, 1765 summative entrustment decisions were reported. Overall, 72.5% (1279 of 1765) of summative entrustment decisions were made with moderate or high confidence. Confidence ratings increased with increasing mean number of EPA microassessments, with 1.7 (95% CI, 1.4-2.0) at no confidence, 1.9 (95% CI, 1.7-2.1) at slight confidence, 2.9 (95% CI, 2.6-3.2) at moderate confidence, and 4.1 (95% CI, 3.8-4.4) at high confidence. Increasing number of EPA microassessments was associated with increased likelihood of higher CCC confidence for all except 1 EPA phase after controlling for program effects (odds ratio range: 1.21 [95% CI, 1.07-1.37] for intraoperative EPA-4 to 2.93 [95% CI, 1.64-5.85] for postoperative EPA-2); for preoperative EPA-3, there was no association.Conclusions and RelevanceIn this cohort study, the CCC confidence in EPA summative entrustment decisions increased as the number of EPA microassessments increased, and CCCs endorsed moderate to high confidence in most entrustment decisions. These findings provide early validity evidence for this novel assessment framework and may inform program practices as EPAs are implemented nationally.

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The surgical consult entrustable professional activity (EPA): Defining competence as a basis for evaluation

Cited by 17 publications

References 22 publications

Competency-Based Education: Will This be the New Training Paradigm in Plastic Surgery?

Competency-Based Education: Will This be the New Training Paradigm in Plastic Surgery?

Fundamentos para un currículo nacional en Cirugía General basado en competencia: Consenso Delphi de la División de Educación de la Asociación Colombiana de Cirugía

Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities

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