Seeing potential opportunities for teaching (SPOT): Evaluating a bundle of interventions to augment entrustable professional activity acquisition

INTRODUCTION: Within the Canadian competency-based medical education system, entrustable professional activities (EPAs) are used to assess residents on performed clinical duties. This study aimed to determine whether implementing a bundle of two interventions (a case-based discussion intervention and a rotation-based nudging system) could increase the number of EPA assessments that could occur for our trainees. METHODS: The authors designed an intervention bundle with two components: 1) a case-based workshop where trainees discussed which EPAs could be assessed with multiple cases and 2) a nudging system wherein each trainee was reminded of EPAs that would be useful to them on each rotation in their first year. We conducted a retrospective program evaluation to compare the intervention cohort (2019) to two historical cohorts using similar EPAs (2017, 2018). RESULTS: Data from 22 trainees (seven in 2017, eight in 2018, and seven in 2019) were analyzed. There was a marked increase in the total number of EPA assessments acquired in the 2019 cohort (average per resident = 285.7, 95% confidence interval [CI] = 256.1 to 312.3, range = 195-350) compared to the two other years (2018 [average = 132.4, 95% CI = 107.5 to 157.02, range = 107-167] and 2017 [70.1, 95% CI 45.3 to 91.0, range = 49-95]), yielding an effect size of Cohen's d = 4.02 for our intervention bundle. CONCLUSIONS: Within the limitations of a small sample size, there was a strong effect of introducing two interventions (a case-based orientation and a nudging system) upon EPA assessments with PGY-1 residents. These strategies may be useful to others seeking to improve EPA assessment numbers in other specialties and clinical environments.