Work

Non-core entrustable professional activities (EPAs) assessments enhance understanding of resident entrustment progression

Year: 2025

Type: article

Abstract: Purpose Although the American Board of Surgery established 18 core general surgery entrustable professional activities (EPAs), procedures not included in the core list (non-core EPAs) comprise a substantial portion of residents’ case volumes at quaternary referral centers. Comparing core and non-core EPAs may help to better characterize resident progression and preparation for fellowship training. Methods We retrospectively analyzed EPA assessment data from a large quaternary referral center. Faculty completed assessments for the 18 core EPAs and used a “non-core” category for procedures not included in that list. Assessments were stratified by postgraduate year (PGY) to assess completion across training levels. A mixed-effects linear regression model compared entrustment-supervision (ES) scores (1 = observation to 4 = practice ready) between core and non-core assessments, accounting for individual resident performance. Results Between June 2022 and July 2024, we collected 1135 core and 558 non-core EPA assessments. Senior residents completed more non-core EPA assessments, with PGY5 residents completing the most (PGY1: 43; PGY2: 141; PGY3: 115; PGY4: 64; PGY5: 235).The most common non-core procedures were pancreatectomy ( n = 74), gastrectomy ( n = 67), ostomy reversal ( n = 60), pediatric central line ( n = 52), and hepatectomy ( n = 45). Mixed-effects modeling showed that ES scores were significantly higher for core EPAs ( F = 9.37, p < 0.01). PGY level significantly predicted ES scores ( F = 279.45, p < 0.001), and only a small proportion of score variability (variance = 0.05) was attributable to resident differences. Conclusions Non-core EPAs reflect complex operations with lower entrustment levels. Non-core EPAs provide clarity on the progression of entrustment as case complexity increases. Incorporating non-core EPA assessments may enhance assessment of senior residents.

Source: Global Surgical Education - Journal of the Association for Surgical Education

DOI: 10.1007/s44186-025-00380-8