Defining Consult Competence: A novel Tool for Evaluating the Surgical Consult Entrustable Professional Activity (EPA)
*Ryland S Stucke1, Meredith J Sorensen1, *Alexandra Rosser2, *Sarah Sullivan2
1Dartmouth-Hitchcock Medical Center, Lebanon, NH;2University of Wisconsin - Madison, Madison, WI
Objective: The American Board of Surgery has proposed a residency redesign, which relies on entrustable professional activities (EPAs). Entrustable professional activities are holistic descriptions of behaviors and performance standards to be met by the end of residency. Accurate and meaningful tools for evaluation and feedback of EPAs are lacking. No framework or tool exists to evaluate surgical consultation, one of the five proposed initial EPAs. Design: Qualitative methods (cognitive task analysis, semi-structured interviews, focus groups) with key teaching faculty. Results were systematically analyzed. Evaluation tool was created, piloted, and refined. Setting: Two academic centers in distinct geographic regions (New England, Mid-West). Participants: 19 key teaching faculty participated in qualitative interviews. Additional faculty and resident participation in focus groups and pilot testing. Main outcome measure: Critical procedural steps and performance traits of a consult were identified. These were combined with recently published standards from the American Board of Surgery’s (ABS) EPA working group to crate the evaluation tool. Interventions: N/A. Results: Qualitative interviews yielded discreet consult procedural steps and performance traits with good thematic saturation and inter-institutional consistency. Results were merged with newly published recommendation from the ABS EPA working group. A competence scale was developed based on clinical narratives. The scale ranges from critically deficient (level 0) to competent (level 4). The tool also captures a synopsis of feedback given to the resident and rationale for why a particular performance level was chosen. Pilot testing demonstrated good feasibility and acceptability of the tool. Conclusions: Accurate evaluation tools are needed to make appropriate entrustment decisions for surgical trainees. This evidence-based tool is the first of its kind to evaluate a surgical consult performed by residents.
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