Practice Readiness of Chief Residents in a National Sample During the First Year of EPA Assessments.

Abstract

Identify the prevalence of practice-ready formative entrustable professional activity (EPA) assessments obtained by residents in their final year of general surgery training. EPA microassessments will be required for admissibility to American Board of Surgery general surgery certification beginning in 2028. EPA implementation began in July 2023 as the initial step in complying with these requirements. EPA microassessments using the ABS entrustment scale (1=limited participation, 2=direct supervision, 3=indirect supervision, 4=practice ready) were completed in real time through a secure application. Deidentified data were downloaded at year end for programs, faculty assessors, and individual residents. Assessments of PGY5 residents by faculty were included. Descriptive statistics were utilized to summarize entrustment ratings and compared across the academic year (July 1, 2023-May 31, 2024) with χ 2 tests. A majority of PGY5 residents (n=1032, 67%) were assessed with 12,611 microassessments (mean 12.2/resident). All EPAs were assessed, with the most in gallbladder disease (n=2950). Median entrustment was practice-ready for all EPAs except renal replacement therapy and thyroid/parathyroid disease (median rating indirect supervision for both). Overall, 63% of microassessments (n=7946) during the chief year were practice-ready, with 59% (5571/9460) intraoperatively and 75% nonoperatively (2375/3151). In July 2023, 56% of PGY5 microassessments were rated indirect supervision or lower compared with 26% in May 2024. The majority of formative microassessments of PGY5 residents in general surgery training programs demonstrate practice readiness for 16 of 18 EPAs. Competence of chief residents grows from the beginning to the end of the PGY5 year for core general surgery activities.