Comparing Entrustable Professional Activity Scores Given by Faculty Physicians and Senior Trainees to First-Year Residents.

Introduction Competency by Design (CBD) began on July 1, 2019, for postgraduate year 1 (PGY1) Canadian Core Internal Medicine (CIM) residents. Many entrustable professional activity (EPA) observations allow for assessment by either a faculty physician, senior medicine resident (SMR), or subspecialty resident (SSR). However, few studies exist that compare EPA scores and comments given by faculty vs senior trainees (SMRs and SSRs). This study aimed to identify differences in EPA scores and comments given to PGY1 residents by faculty physicians vs senior trainees. Methods Scores and comments of EPAs completed between July 1, 2019, and June 30, 2020, for 35 CIM PGY1 residents were extracted anonymously from the University of Alberta CBD platform. Scores from faculty vs senior trainees were compared with the Mann-Whitney U test and the Kruskal-Wallis test. Word counts for positive and constructive comments written by faculty vs senior trainees were compared with the independent t-test and one-way ANOVA. The most common two-word phrases in comments were identified with QI Macros software (Denver, CO: KnowWare International, Inc.). Results A total of 2226 EPAs were observed. Faculty physicians gave significantly lower EPA scores overall compared to senior trainees (U = 501706, P <0.001). Constructive comments written by faculty (M = 14.06, SD = 16.84) had lower word counts compared to senior trainees (M = 15.85, SD = 16.43) for overall EPAs (t{2224} = -2.528, P = 0.012). Conclusion Faculty physicians gave lower EPA scores and had lower word counts on constructive comments, compared to senior trainees. These results may help the ongoing implementation of Competence by Design.