Setting standards of performance expected in neurosurgery residency: A study on entrustable professional activities in competency-based medical education.

BACKGROUND: Competency-based medical education requires evaluations of residents' performances of tasks of the discipline (ie. entrustable professional activities (EPAs)). Using neurosurgical Faculty perspectives, this study investigated whether a sample of neurosurgical EPAs accurately reflected the expectations of general neurosurgical practice. METHOD: A questionnaire was sent to all Canadian neurosurgery Faculty using a SurveyMonkey® platform. RESULTS: The proportion of respondents who believed the EPAs were representative of general neurosurgery competences varied significantly across all EPAs [47%-100%] (p < 0.0001). For 9/15 proposed EPAs, ≥75% agreed they were appropriate for general neurosurgery training and expected residents to attain the highest standard of performance. However, a range of 27-53% of the respondents felt the other six EPAs would be more appropriate for fellowship training and thus, require a lower standard of performance from graduating residents. CONCLUSION: The shift towards subspecialization in neurosurgery has implications for curriculum design, delivery and certification of graduating residents.

Resident evaluations in the age of competency-based medical education: faculty perspectives on minimizing burdens.

OBJECTIVE: Competency-based medical education (CBME), an outcomes-based approach to medical education, continues to be implemented across many postgraduate medical education programs worldwide, including a recent introduction into Canadian neurosurgical training programs (July 2019). The success of this educational paradigm shift requires frequent faculty observation and evaluation of residents performing defined tasks of the specialty. A main challenge involves providing residents with frequent performance evaluations and feedback that are feasible for faculty to complete. This study aims to define what is currently happening and what changes are needed to make CBME successful for the certification of neurosurgeons' competence. METHODS: A 55-item questionnaire was emailed nationwide to survey Canadian neurosurgical faculty. RESULTS: Fifty-two complete responses were received and achieved a distribution highly correlated with the number of faculty neurosurgeons practicing in each Canadian province (Pearson's r = 0.94). Two-thirds (35/52) of faculty reported currently taking a median of 10 minutes to complete evaluation forms at the end of a resident's rotation block. Regardless of the faculty's province of practice (p = 0.50) or years of experience (p = 0.06), they reported 3 minutes (minimum 1 minute, maximum 10 minutes, interquartile range [IQR] 3 minutes) as a feasible amount of time to spend completing an evaluation form following an observation of a resident's performance of an entrustable professional activity (EPA). If evaluation forms took 3 minutes to complete, 85% of respondents (44/52) would complete EPA evaluations weekly or daily. The faculty recommended 5 minutes as a feasible amount of time to provide oral feedback (minimum 1 minute, maximum 20 minutes, IQR 3.25 minutes), which was significantly higher (p = 0.00099) than their recommended amount of time for completing evaluation forms. The majority of faculty (71%) stated they would prefer to access resident evaluation forms through a mobile application compared to a paper form (12%), an evaluation website (8%), or through a URL link sent via email (10%; p = 0.0032). CONCLUSIONS: To facilitate the successful implementation of CBME into a neurosurgical training curriculum, resident EPA assessment forms should take 3 minutes or less to complete and be accessible through a mobile application.