Wise Words: The EPAs Are Coming!

The General Surgery Residency program has long stood at the forefront of surgical education, and with the nationwide launch of the American Board of Surgery’s General Surgery Entrustable Professional Activities program nationwide, we are eager to help advance our program and practices into the future. Our goal has always been to prepare our trainees for successful, well-rounded careers in surgery, and we hope the ABS EPA program will allow us to focus on individual competency and autonomy in surgical training to do just that.

The goal of the EPA program is to transition to a competency-based assessment system in residency programs across the nation. Long term, the goal is to replace typical assessments so that residents can receive feedback at every point in their educational journey. This will hopefully allow quicker progression in areas where residents excel and offer more attention to specific areas in which they need improvement. The program includes 18 EPAs in which general surgery residents will need to achieve competency and autonomy to graduate from their program, with subcompetencies broken down into pre-, intra-, and post-operative care areas. Within this new assessment system, faculty will be able to record observations of residents’ performances at every step in their training and note where they excel and where they can improve. These assessments are intended to be more personalized and allow for more data and feedback for residents throughout the course of their training, starting from the very beginning. Feedback is an essential component for residents, and the implementation of EPAs hopes to allow for more communication and more personalized advancement through the residency program. There are four stages of competency residents will move through for each EPA, starting from very basic knowledge to practice-ready autonomy. This will allow residents to receive the necessary amount of supervision and assistance from faculty depending on their individual achievements and progress and will allow them to gain independence in procedures when they are ready for it.

The implementation of EPAs this coming year will be a nationwide cultural change, and as with all change, will come with its challenges. When WashU first participated in the ABS EPA pilot from 2018-2020, low engagement stood out as an early roadblock. Having participated in the pilot, however, our program has garnered early insights which will help us more smoothly integrate EPAs into our daily practices. For the first year of the national EPA launch, the primary goal is progressive engagement. Step by step, we will be adopting this new form of assessment for residents to provide higher quality, more detailed competency-based education. Surgical programs across the nation will be adjusting as well, and we hope to achieve a short-term goal of increased participation and slow adaptation to these new requirements.  

During this first year, ABS will be actively monitoring and striving to employ best practice efforts so that the program will only improve over time. All residents have the opportunity to become a Program Champion and can help by providing feedback to the ABS to ensure residents’ voices are heard. There are many questions we cannot yet answer, but we are seeking small steps toward a large nationwide cultural change for the future. The purpose of the ABS EPA Program is to revolutionize the way we assess residents and to focus on individual autonomy and competencies, and we have high hopes that this change will be more functional and fruitful for faculty and residents alike.

Having participated in the pilot launch, WashU is uniquely positioned to better understand how to approach the nationwide launch of the new ABS EPA program this coming July. We will all be learning and adapting together, and want to assist our residents in as smooth a transition into this new era of surgical education as possible. Providing a quality education is the cornerstone of our General Surgery Residency program, and we intend to keep the needs of our residents and the quality of their education at the forefront of everything we do. As one of the top programs nationwide, we help set the standards for surgical training. We are excited to see the benefits of EPAs in our training programs and to be a part of this cultural shift in surgical education!

Paul Wise, MD
Program Director
General Surgery Residency
Washington University School of Medicine

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