Incentivizing Faculty and Promoting Engagement in General Surgery Residency Entrustable Professional Activities Assessments.

OBJECTIVE

The American Board of Surgery (ABS) implemented Entrustable Professional Activities (EPAs) to facilitate transition to competency-based resident assessments in July 2023. To improve faculty engagement, our institution established an intervention with a required target of less than 25% expired faculty EPA assessments for the 2024 to 2025 academic year (AY) to qualify for a shortened end-of-rotation resident evaluation form.

DESIGN

A retrospective review of de-identified institutional EPA data for the AYs 2023 to 2024, preintervention, and 2024 to 2025, postintervention, obtained from the ABS website was conducted. Faculty rater, division, activity name, phase of care, entrustability score, and narrative feedback were analyzed. Descriptive statistics were employed to assess EPA assessment volume, number of faculty raters and evaluations by division, expired assessments, and details by postgraduate training year (PGY). Chi-Square, 2-proportion z-tests, and paired t-tests were employed to compare pre and postintervention EPA assessment completion and qualities.

SETTING

Affiliate hospitals of the Medical College of Wisconsin including Froedtert Hospital, a tertiary referral center in Milwaukee; Clement J. Zablocki Veteran's Affairs Hospital; and 3 community hospitals in the Milwaukee area.

PARTICIPANTS

De-identified data from general surgery residents and faculty who completed any EPA assessment in AYs 2023 to 2024 and 2024 to 2025 were included.

RESULTS

A total of 1111 and 1464 EPA assessments were completed for the 2023 to 2024 and 2024 to 2025 AYs, respectively, yielding a 1.32-fold increase post-intervention. There was a 1.27-fold increase in participating faculty raters (63 vs 80). Meaningful narrative feedback increased from 53.3% to 57.8% (p = 0.02). Of 11 service rotations with participating faculty raters, 5 met the <25% EPA assessment expiration metric in 2023 to 2024, compared to 8 in 2024 to 2025. The overall EPA assessment expiration rate decreased from 40.0% pre-intervention to 13.9% postintervention (p < 0.001).

CONCLUSIONS

Incentivizing faculty to improve upon expired EPA assessments using a shortened end-of-rotation resident evaluation form increased EPA assessment completion, improved narrative feedback quality, and decreased expired EPA assessments. Initiatives to motivate faculty and residents to engage in timely and high-quality feedback will aid the ongoing transition to competency-based surgical education.