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Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities.
Montgomery, Kelsey B; Mellinger, John D; McLeod, M Chandler; Jones, Andrew; Zmijewski, Polina; Sarosi, George A; Brasel, Karen J; Klingensmith, Mary E; Minter, Rebecca M; Buyske, Jo; Lindeman, Brenessa.
Affiliation
  • Montgomery KB; Department of Surgery, University of Alabama at Birmingham.
  • Mellinger JD; American Board of Surgery, Philadelphia, Pennsylvania.
  • McLeod MC; Department of Surgery, Southern Illinois University, Springfield.
  • Jones A; Department of Surgery, University of Alabama at Birmingham.
  • Zmijewski P; American Board of Surgery, Philadelphia, Pennsylvania.
  • Sarosi GA; Department of Surgery, University of Alabama at Birmingham.
  • Brasel KJ; Department of Surgery, University of Florida, Gainesville.
  • Klingensmith ME; Department of Surgery, Oregon Health & Science University, Portland.
  • Minter RM; American Board of Surgery, Philadelphia, Pennsylvania.
  • Buyske J; Accreditation Council for Graduate Medical Education, Chicago, Illinois.
  • Lindeman B; Department of Surgery, Washington University in St Louis, St Louis, Missouri.
JAMA Surg ; 159(7): 801-808, 2024 Jul 01.
Article in En | MEDLINE | ID: mdl-38717759
ABSTRACT
Importance A competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs' clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known.

Objective:

To identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions. Design, Setting, and

Participants:

This cohort study used deidentified data from the EPA Pilot Study, with participating sites at 28 general surgery residency programs, prospectively collected from July 1, 2018, to June 30, 2020. Data were analyzed from September 27, 2022, to February 15, 2023. Exposure Microassessments of resident entrustment for pilot EPAs (gallbladder disease, inguinal hernia, right lower quadrant pain, trauma, and consultation) collected within the course of routine clinical care across four 6-month study cycles. Summative entrustment ratings were then determined by program CCCs for each study cycle. Main Outcomes and

Measures:

The primary outcome was CCC decision-making confidence rating (high, moderate, slight, or no confidence) for summative entrustment decisions, with a secondary outcome of number of EPA microassessments received per summative entrustment decision. Bivariate tests and mixed-effects regression modeling were used to evaluate factors associated with CCC confidence.

Results:

Among 565 residents receiving at least 1 EPA microassessment, 1765 summative entrustment decisions were reported. Overall, 72.5% (1279 of 1765) of summative entrustment decisions were made with moderate or high confidence. Confidence ratings increased with increasing mean number of EPA microassessments, with 1.7 (95% CI, 1.4-2.0) at no confidence, 1.9 (95% CI, 1.7-2.1) at slight confidence, 2.9 (95% CI, 2.6-3.2) at moderate confidence, and 4.1 (95% CI, 3.8-4.4) at high confidence. Increasing number of EPA microassessments was associated with increased likelihood of higher CCC confidence for all except 1 EPA phase after controlling for program effects (odds ratio range 1.21 [95% CI, 1.07-1.37] for intraoperative EPA-4 to 2.93 [95% CI, 1.64-5.85] for postoperative EPA-2); for preoperative EPA-3, there was no association. Conclusions and Relevance In this cohort study, the CCC confidence in EPA summative entrustment decisions increased as the number of EPA microassessments increased, and CCCs endorsed moderate to high confidence in most entrustment decisions. These findings provide early validity evidence for this novel assessment framework and may inform program practices as EPAs are implemented nationally.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: General Surgery / Clinical Competence / Decision Making / Internship and Residency Limits: Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: JAMA Surg Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: General Surgery / Clinical Competence / Decision Making / Internship and Residency Limits: Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: JAMA Surg Year: 2024 Document type: Article