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Practice Readiness of Chief Residents in a National Sample During the First Year of EPA Assessments
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Brenessa Lindeman1, *Chandler Scott-Smith
2, *Andrew Jones
2, George A. Sarosi
3, Rebecca Minter
4, *Sarah Jung
4, *Jonathan Jesneck
5, *Ruchi Thanawala
6, John Mellinger
2, *Carol L. Barry
2, Jo Buyske
2, Karen Brasel
21Surgery, University of Alabama at Birmingham, Birmingham, AL; 2American Board of Surgery, Philadelphia, PA; 3Surgery, University of Florida, Gainesville, FL; 4Surgery, University of Wisconsin, Madison, WI; 5Firefly Lab, Portland, OR; 6Surgery, Oregon Health Science University, Portland, OR
Objective: Entrustable Professional Activities (EPAs) will be required for admissibility to American Board of Surgery general surgery certification beginning in 2028. Residency programs began implementing EPAs in 2023 as the initial step in complying with these requirements. We hypothesized that the majority of chief residents would receive practice ready formative assessments and that entrustment ratings would increase from the beginning to end of the academic year.
Methods: EPA microassessments using the ABS entrustment scale (1=limited participation, 2=direct supervision, 3=indirect supervision, 4=practice ready) were uploaded in real time through a secure application and stored securely. Deidentified data were downloaded at year end for programs, faculty assessors and individual residents. Assessments completed of PGY5 residents by faculty were included for analysis. Descriptive statistics (mean +/- SD, median) were utilized to summarize entrustment ratings across EPAs and levels of complexity, and compared across the academic year (July 1, 2023 to May 31, 2024 given variance in year-end transition date) with Chi-square tests.
Results: PGY5 residents from 265 programs (n=1,032, 67% of all chief residents) were assessed with 12,611 microassessments, a mean of 12.2 (SD 19.5) per resident. Assessments were completed for all EPAs, with the fewest in pancreatitis (53) and the most in gallbladder disease (2,950). The median formative entrustment rating for PGY5 residents was practice ready for all EPAs except renal replacement therapy and thyroid and parathyroid disease, for which the median rating was indirect supervision. The majority of all EPA microassessments of residents during the chief year (n=7,946, 63%) were at the practice ready level. Comparing phase of care, 59% of intraoperative assessments (5,571/9,460) were rated as practice ready, compared to 75% of nonoperative assessments (2,375/3,151). Mean (SD) entrustment ratings during July 2023 were 3.28 (0.75), compared to 3.67 (0.61) during May 2024, p<0.001 (Figure 1). In July 2023, 56% of PGY5 resident microassessments had ratings of indirect supervision or lower compared to 26% in May 2024. In May 2024, only 6% of PGY5 resident microassessments had entrustment ratings of direct supervision. Case complexity had a small magnitude but statistically significant influence on entrustment ratings, with PGY5 residents in straightforward, moderate, and complex cases rated as practice ready, respectively, in 54%, 34%, and 42% in July 2023 vs 81%, 71%, and 71% in May 2024, p<0.001 for all.
Conclusions: The majority of formative microassessments of PGY5 residents in general surgery training programs demonstrate practice readiness in 16 of 18 EPAs. These data highlight that the competence of chief residents grows from the beginning to the end of the PGY5 year for core general surgery activities, and allow for more transparent communication regarding where additional support may be needed.
Figure 1. Percentage of PGY5 assessments at each value of entrustment rating
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