Merits and demerits of entrustable professional activities for assessments of surgical residents: A systematic review

OBJECTIVE : For competency-based medical education (CBME), there has been increasing focus on entrustable professional activities (EPA) as one of the modalities for assessment of competence. This study aims to investigate the effectiveness, the merits and the demerits of EPAs for evaluation of the competency of the surgical trainees. DESIGN : We performed a systematic literature search in PubMed, EMBASE, MEDLINE, and ERIC. Keywords used for searching included “entrustable professional activity”, “surgery”, “surgical”, “resident” and “residency”. The search was limited to the English language but not limited to the publication time. The searched articles were included in this study if the searched articles were related to “entrustable professional activity” and “surgical residency”. SETTING : Included studies were published from 2016 to 2022 and were written in English. PARTICIPANTS : From 67 studies retrieved from the databases, 12 articles were included in this study after screening. There were totally 1990 surgical residents and 1165 faculty included in these studies. Results : By EPA assessments, it was found the performance of the senior residents was better than that of the junior residents. However, there was no significant difference between junior surgical residents and medical students for the abilities of using concise, clear and comprehensive professional clinical language to do a handover with other health care professionals. There were significant amount of surgical residents had no or faint idea about EPA assessments. Regardless of pre-operative, intra-operative and post-operative assessments, EPAs could be as effective as milestones for evaluation. Conclusion : EPAs could be a good tool for assessment of the abilities of surgical residents and could differentiate the abilities between senior and junior surgical trainees, but multiple EPAs should be used for comprehensive evaluation and the ability of communication with other professional healthcare givers by using clear, concise and comprehensive clinical language seemed to be left behind. In addition to assess the clinical abilities by EPAs, the ability of communication should not be neglected and should be emphasized.