The American Board of Surgery (ABS) is taking a step forward in modernizing how surgical training is assessed and evaluated. The ABS recently announced its Entrustable Professional Activities (EPA) Project, which will launch in July 2023 for general surgery residency programs. This project aims to develop a competency-based assessment for general surgery trainees and represents a significant change from traditional time-based residency training models.
The ABS EPA Project: An Overview
For many years, discussions have been underway regarding the need for innovative training models to address the ever-changing nature of surgical practice. The ABS began exploring using EPAs as a potential solution in 2016. EPAs are defined as "units of professional practice that can be fully entrusted to a trainee as soon as he or she has demonstrated the necessary competence to execute the activity unsupervised."
Entrustable Professional Activities (EPA) represent a set of core activities in which a surgeon should be competent before being considered for board certification.
The ABS EPA Project began with the development of five index EPAs piloted at 28 diverse surgical residency programs from 2018-2020. From there, the project developed 18 General Surgery EPAs representing the core elements of general surgical practice. These EPAs allow for frequent and longitudinal assessment of individual resident performance, autonomous and competency-based practice preparation, and meaningful feedback.
While EPAs are not competencies themselves, they serve in a complementary fashion, ensuring that educators and trainees understand how to translate these competencies into everyday clinical practice. Additionally, because EPAs are directly-observed activities, they allow for real-time decision-making and assessment by attending physicians to appropriately grant conditional independence and autonomy as trainees progress throughout their training.
The ABS EPA Project's Technology Platform
The ABS also developed a mobile-based technology platform that allows for time-efficient, feedback-oriented assessment of resident performance during the daily workflow. This platform is provided free of charge to all ACGME-accredited general surgery training programs.
ABS EPA App Technology Webinar
EPA Alternative Technology Webinar
ABS Incoming General Surgery Intern EPA Webinar
The Potential Impact of the ABS EPA Project
This new assessment paradigm has the potential to reframe the culture of surgical training and create a habit of workplace-based micro-assessment and improvement-oriented performance feedback linked to core competencies and milestones. The ultimate goal is to fulfill every surgeon's commitment to honor the public trust by creating a new model for surgical training focused on educational outcomes, excellence, and the highest standards in patient care.
The ABS EPA Project is significant for general surgery trainees and the entire surgical profession. The use of EPAs, in addition to the ACGME competencies and milestones, could become a standard for assessing the competency of all surgical trainees across specialties and determining readiness for independent practice upon graduation. The ABS is already in the early stages of developing EPAs for other ABS specialties, including vascular surgery, pediatric surgery, complex general surgical oncology, and surgical critical care, with plans to introduce this trainee assessment model to those specialty programs in the coming years.
The ABS is collaborating with key surgical education partners and stakeholders nationwide to refine the lessons learned from the EPA pilot experience. The ABS aims to incorporate this strategy into a new standard for surgical training focused on educational outcomes, aiming toward excellence and the highest standards in patient care. The ABS will also employ published scholarship, workshops, and presentations at key surgical education venues to support faculty and residents preparing to engage in this new assessment paradigm.
In conclusion, the ABS EPA Project represents a significant step forward in modernizing how surgical training is assessed and evaluated. This new assessment paradigm has the potential to create a habit of workplace-based micro-assessment and improvement-oriented performance feedback linked to core competencies and milestones, ultimately improving the quality of clinical training experiences for general surgery trainees.
The Role of Germane Solutions
Germane Solutions, a healthcare consulting firm, can assist general surgery residency programs in preparing for the launch of the ABS EPA Project. Germane Solutions' team of experts can help general surgery residency programs understand the implications of the new assessment paradigm and assist with implementing the mobile-based technology platform. Germane Solutions' faculty development programs can also help general surgery residency programs train faculty to engage in this new assessment paradigm effectively. Germane Solutions can also assist in developing policies and procedures, updating current evaluation practices, and integrating EPA into your residency management system and Clinical Competency Committee processes to ensure that the ABS EPA Project is effectively integrated into the existing training program.
For more information, contact Germane Solutions here.
Additional Information For more information about the ABS EPA Project, visit the American Board of Surgery website.
For a collection of publications related to the ABS EPA project, please see here.
For a list of volunteers who have been involved in the ABS EPA Project, including pilot programs and working group members, please see here.