Factors associated with attainment of ad hoc entrustability among Taiwan otolaryngology resident physicians: a nationwide cross-sectional study.

BACKGROUND

Competency-Based Medical Education (CBME) emphasizes workplace-based assessments, yet factors influencing competency attainment remain underexplored. In 2020, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery introduced 11 Entrustable Professional Activities (EPAs), implemented nationwide via the EMYWAY platform in 2022. This study evaluates the nationwide adoption of EPA-based assessments in otolaryngology residency training and identifies factors associated with entrustment-supervision achievements.

METHODS

A cross-sectional analysis reviewed EPA assessments from EMYWAY (August 2022-July 2023). Multivariate regression identified factors affecting attainment of expected entrustment-supervision levels by postgraduate year (R1: Level 2; R2-R3: Level 3; R4: Level 4; R5: Level 5).

RESULTS

A total of 9,345 EPA assessments were conducted across 274 residents in 34 training programs and evaluated by 362 faculty members. Overall, 68.2% (6,377/9,345) of assessments met expected entrustment-supervision levels. Factors negatively associated included training in urban hospitals (OR = 0.50, 95% CI 0.43-0.60), advanced case complexity (OR = 0.44, 95% CI 0.40-0.49), surgical procedures (OR = 0.40, 95% CI 0.34-0.46), and senior residency years (R4: OR = 0.29, 95% CI 0.24-0.35; R5: OR = 0.11, 95% CI 0.09-0.13). Conversely, emergency settings had higher achievement (OR = 4.83, 95% CI 3.70-6.31).

CONCLUSIONS

This study identifies specific challenges in urban hospitals, complex clinical scenarios, surgical contexts, and senior residency training that require targeted interventions. High achievement in emergency settings underscores the value of intensive clinical exposure. Refinements to the EPA framework are necessary to support senior residents' competency development. Future longitudinal research should assess long-term impacts on clinical proficiency and patient outcomes.