The Surgical Education Checklist: A Novel Tool to Improve the Use of Entrustable Professional Activities in Operative Training in Competence by Design

OBJECTIVE: Surgical residents face significant challenges in meeting Entrustable Professional Activity (EPA) assessment requirements under the Competence By Design (CBD) framework, potentially impacting their surgical training and readiness for practice. This study seeks to assess the effectiveness of the Surgical Education Checklist (SEC) in increasing the proportion of completed EPA assessments within the Division of General Surgery. DESIGN: This prospective cohort study implemented the SEC between January 1, 2023, and June 30, 2023. A pre and postchecklist survey collected experiences with the SEC and overall CBD framework. The primary outcome was the proportion of completed EPA assessments. Descriptive statistics were reported and subgroup analyses were performed based on resident postgraduate year (PGY). SETTING: About 5 tertiary academic-affiliated teaching hospitals with McMaster University (Hamilton, Ontario) PARTICIPANTS: All general surgery residents and staff faculty were invited to utilize the survey, with an approximate sample size of 71 participants. The overall response rate was 34 (47.9%) for the prechecklist survey and 11 (15.5%) for the postchecklist survey. RESULTS: The number of EPA assessments triggered increased from 485 to 639, with a significant increase in the absolute number of EPA assessments completed (400 vs 477, p < 0.01). There was an increase in the proportion of expired assessments (85 [17.5%] vs 162 [25.4%], p < 0.01) after the implementation of the SEC. In the subgroup analysis based on resident PGY, PGY1 to 3 general surgery residents triggered significantly more EPA assessments after the implementation of the SEC. CONCLUSIONS: The SEC demonstrated its effectiveness as a perioperative prompt for triggering EPA assessments, particularly amongst junior general surgery residents, indicating its potential to facilitate early engagement with essential surgical training tasks. However, there remains gaps in follow-through and completion of triggered EPA assessments.