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Implementing Entrustable Professional Activities in Plastic Surgery Residency Training
Israel O. Falade
1, Chelsea C. Yim
*2, Esther A. Kim
21School of Medicine, University of California, San Francisco, San Francisco, CA; 2Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco, CA
Background:
Entrustable Professional Activities (EPAs) offer a competency-based framework that allows trainees to perform tasks with varying supervision levels as they demonstrate competence. While EPAs are used in several surgical specialties, plastic surgery (PS) lacks a formal EPA curriculum. This study describes the design and first implementation of an EPA assessment tools in a PS residency program.
Methods:
An EPA framework was developed based on Olle ten Cate's principles, aligned with Accreditation Council for Graduate Medical Education competencies, and adapted from the American Board of Surgery's EPA guidelines. Entrustment levels were categorized from limited participation to practice-ready, with competencies organized into three phases: preoperative, intraoperative, and postoperative. Each EPA contained 4-5 questions and underwent review by residents, directors, and educators. The framework was intentionally generalized to cover a wide scope of PS cases. QR code badges linked to assessments were distributed to facilitate real-time feedback
Results:
Since its launch in July 2024, 20-25 EPA assessments have been completed monthly with 90% focused on intraoperative phase. Senior residents were evaluated more frequently, reflecting their higher surgical case volumes. Recognizing that residents often perform specific portions of a procedure based on their level, "Nested" EPAs were developed. Senior residents commonly supervised junior residents, leading to assessments where seniors evaluated juniors under their supervision.
Conclusions:
While core EPAs by the American Board of Plastic Surgery (ABPS) is anticipated, our findings underscore the value of institution-specific EPAs, nested EPAs, and peer-assessments in enhancing residency education. Early feedback has led to more structured performance reviews, clearer expectations, and the identification of areas for improvement. These preliminary insights may inform the future development of core EPAs by ABPS and potentially serve as a foundation for multi-center studies.
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