Gupta Aakanksha, Watkins Anthony C, Fahey Thomas J, Barie Philip S, Narayan Mayur
Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York.
Division of Transplantation, Department of Surgery, Weill Cornell Medicine, New York, New York.
J Surg Educ. 2020 May-Jun;77(3):520-526. doi: 10.1016/j.jsurg.2019.12.005. Epub 2020 Jan 14.
The American Board of Surgery has initiated a pilot study to investigate the incorporation of Entrustable Professional Activities (EPAs) into the training of general surgery residents (GSR). Limited data exist on perception of EPAs by GSR. We aimed to assess the impact of EPAs on GSR for 2 included program topics: inguinal hernia and general surgery consultation.
A 21-question, cross-sectional, Likert scale survey was distributed to 64 GSR at an urban university hospital to assess perceptions and apprehensions regarding EPA implementation. The Mann-Whitney U test was used to analyze differences in responses between junior residents (PGY 1-3) and senior residents (PGY 4-5), and by gender of respondent, α = 0.05.
Forty-one (64%) GSR completed surveys. Approximately one-half of respondents had "faint to some" knowledge about EPAs. Fifty-seven percent of GSR were "moderately to highly concerned" about being assessed by attending surgeons with whom they did not have a prior relationship. Additionally, concerns were raised about being assessed by attending surgeons who may have observed their patient interaction only in part. Most GSR expressed "little to no concern" about impact of EPAs to potentially increase workload, the view of their program director as to their clinical competency, or American Board of Surgery plans to use collected data. Forty-two percent GSR in PGY 1 to 3 were "moderately to highly" concerned about impact on progression to the next year of residency, whereas senior GSR had "little to no concern." Most GSR (57%) expressed "moderate to high" concern about emergency medicine attending physicians evaluating them. Similar themes regarding EMA evaluation were identified in the comments section of the survey.
EPAs are intended to be a major part of GSR's competency-based assessment and advancement. More work needs to be done to alleviate concerns as to who should provide assessments, as well as in defining how EPAs will be used to assess clinical competency.
美国外科委员会已启动一项试点研究，以调查将可托付专业活动（EPA）纳入普通外科住院医师（GSR）培训的情况。关于GSR对EPA的看法的数据有限。我们旨在评估EPA对GSR在两个纳入项目主题方面的影响：腹股沟疝和普通外科会诊。
向一所城市大学医院的64名GSR发放了一份包含21个问题的横断面李克特量表调查问卷，以评估他们对EPA实施的看法和担忧。采用曼-惠特尼U检验分析初级住院医师（PGY 1-3）和高级住院医师（PGY 4-5）之间以及按受访者性别划分的回答差异，α = 0.05。
41名（64%）GSR完成了调查。约一半的受访者对EPA有“模糊到一定程度”的了解。57%的GSR“中度到高度担心”会被他们之前没有关系的主治外科医生评估。此外，有人担心会被只部分观察过他们与患者互动的主治外科医生评估。大多数GSR对EPA可能增加工作量的影响、项目主任对其临床能力的看法或美国外科委员会使用收集数据的计划表示“几乎不担心”。PGY 1至3年级的GSR中有42%“中度到高度担心”对进入下一年住院医师培训的影响，而高级GSR“几乎不担心”。大多数GSR（57%）对急诊医学主治医生评估他们表示“中度到高度担心”。在调查问卷的评论部分也发现了关于EMA评估的类似主题。
EPA旨在成为GSR基于能力的评估和晋升的主要部分。在减轻对谁应提供评估的担忧以及确定EPA将如何用于评估临床能力方面，还需要做更多工作。
