Simulating success: Applying EPA assessments to simulation in surgical education.

Abstract

Entrustable professional activities are a competency-based evaluation framework which was deployed by the American Board of Surgery in 2023 to evaluate general surgical residents and provide a path to independent practice. Entrustable professional activity microassessments are based on 18 conditions which are core to being a practicing general surgeon, and most include multiple phases of care, such as preoperative care, intraoperative care, and postoperative care. These evaluations are an amalgam of all the clinical competencies, including medical knowledge and patient care skills. Many concerns have arisen about declining practice readiness of general surgery trainees over the past couple of decades, while simulation in surgical education has emerged over a similar time frame. Simulation has the potential to boost trainee confidence, prepare trainees for specific clinical scenarios, and provide a means to practice core operative maneuvers. Traditional evaluation of trainees participating in simulated scenarios is variable, and the entrustable professional activity framework has the potential to lend structure to simulated scenarios such that they may more closely model a path to operative autonomy and independence while familiarizing early-stage trainees with the entrustable professional activity evaluation format. However, these simulations are just that-a simulated environment whose efficacy hinges upon its similarity to actual clinical care. Entrustable professional activity assessments of simulated scenarios, while potentially valuable, should not be used as actual resident evaluations, as they cannot replace authentic clinical training.