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Purpose <p>The American Board of Surgery (ABS) Entrustable Professional Activity (EPA) initiative aims to address the deficit of data on entrustment outside the operating room. We hypothesize that current EPA assessments may inadequately capture key observable behaviors (OBs) critical to non-operative entrustment, particularly in the clinic and hospital preoperative area.</p> Methods <p>We conducted a survey-based analysis to explore faculty perceptions of EPAs and to identify potential discordances of current practices of non-operative entrustment. The pre- and postoperative phases of the 10 most frequently completed general surgery EPAs from a national dataset were mapped to 21 generalized OBs (gOBs). Faculty identified where OBs relevant to non-operative entrustment are observed, and which OBs drive entrustment. Surveys were distributed to faculty across 18 US general surgery programs. Chi-square and Fisher’s exact tests were used for categorical associations, and descriptive statistics were calculated for numerical data.</p> Results <p>Of the 200 faculty, 43 (21.5%) from 12 institutions and 11 specialties responded. 70% received formal EPA training and 64.7% reported strong understanding of EPAs. Faculty agreed EPAs are effective and support resident development (median: 4; IQR 3–4). The hospital ward and ED were the most common sites for gOB observation (<i>p</i> &lt; 0.05). Faculty reported a median of 10 preoperative and 4 postoperative gOBs necessary to determine entrustment. Key drivers for entrustment in the pre and postoperative phases included understanding surgical indications and anticipating early postoperative complications.</p> Conclusion <p>Although faculty report a positive perception and strong understanding of EPAs, a clear discordance exists between ABS expectations and faculty-reported practice. Current EPAs are poorly suited to assess competencies in the outpatient clinic, hospital preoperative area and the ICU, as intended. Targeted faculty education, along with setting-specific or streamlined EPAs represents an actionable strategy to improve assessment of nonoperative competencies.</p>

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A real-world evaluation of non-operative EPA assessment practice patterns

  • 期刊论文

  • 发表日期：

    2026年2月25日

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  • Carolyn C. Chang,
  • Phillip Jenkins,
  • Jonathan Jesneck,
  • Julie Doberne,
  • Ruchi Thanawala

摘要

Purpose

The American Board of Surgery (ABS) Entrustable Professional Activity (EPA) initiative aims to address the deficit of data on entrustment outside the operating room. We hypothesize that current EPA assessments may inadequately capture key observable behaviors (OBs) critical to non-operative entrustment, particularly in the clinic and hospital preoperative area.

Methods

We conducted a survey-based analysis to explore faculty perceptions of EPAs and to identify potential discordances of current practices of non-operative entrustment. The pre- and postoperative phases of the 10 most frequently completed general surgery EPAs from a national dataset were mapped to 21 generalized OBs (gOBs). Faculty identified where OBs relevant to non-operative entrustment are observed, and which OBs drive entrustment. Surveys were distributed to faculty across 18 US general surgery programs. Chi-square and Fisher’s exact tests were used for categorical associations, and descriptive statistics were calculated for numerical data.

Results

Of the 200 faculty, 43 (21.5%) from 12 institutions and 11 specialties responded. 70% received formal EPA training and 64.7% reported strong understanding of EPAs. Faculty agreed EPAs are effective and support resident development (median: 4; IQR 3–4). The hospital ward and ED were the most common sites for gOB observation (p < 0.05). Faculty reported a median of 10 preoperative and 4 postoperative gOBs necessary to determine entrustment. Key drivers for entrustment in the pre and postoperative phases included understanding surgical indications and anticipating early postoperative complications.

Conclusion

Although faculty report a positive perception and strong understanding of EPAs, a clear discordance exists between ABS expectations and faculty-reported practice. Current EPAs are poorly suited to assess competencies in the outpatient clinic, hospital preoperative area and the ICU, as intended. Targeted faculty education, along with setting-specific or streamlined EPAs represents an actionable strategy to improve assessment of nonoperative competencies.