The Path to Independence

BACKGROUND: In 2016 the American Board of Surgery introduced Entrustable Professional Activities (EPAs) as an assessment framework to support competency-based education within General Surgery. EPAs operationalize milestones and competencies into a practical assessment framework, enabling timely, targeted feedback and progressive entrustment. OBJECTIVE: We hypothesize that variability in trainee entrustment may identify specific EPAs that function as performance targets, allowing earlier identification of trainees who may need additional support. METHODS: National ABS EPA data for PGY-1 through PGY-5 residents from July 2023-July 2025 were reviewed. Microassessments (MAs) using the ABS entrustment scale (1=Limited Participation; 4=Practice Ready) were compared by EPA, phase, and post-graduate year. Descriptive statistics summarized formative entrustment ratings and progression within post-graduate year. RESULTS: Subjects included 9,932 residents from 345 programs, with 185,901 EPA MAs. For several intraoperative EPAs, over half of trainees achieved a median formative assessment of Indirect Supervision/Practice Ready at the PGY-3 level including appendicitis (58.2%, n=819), abdominal wall hernia (50.4%, n=618), breast disease (52.7%, n=309), and cutaneous/subcutaneous neoplasm (66%, n=325). Colon disease (73.4%, n=756), gallbladder disease (86.6%, n=1410), inguinal hernia (76.5%, n=734), and thyroid/parathyroid disease (61.3%, n=184) showed a slower progression, not achieving 50% of residents until the PGY-4 level. Earlier progression was noted for soft tissue infection with 54.8% (n=355) attaining indirect supervision or higher at the PGY-2 level. CONCLUSIONS: The introduction of EPAs and shift towards competency-based assessment enables the identification of periods of rapid entrustment progression and supports the identification of targets that may facilitate the development of a competency-based training framework.