Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities.

Autor:	Montgomery KB; Department of Surgery, University of Alabama at Birmingham., Mellinger JD; American Board of Surgery, Philadelphia, Pennsylvania.; Department of Surgery, Southern Illinois University, Springfield., McLeod MC; Department of Surgery, University of Alabama at Birmingham., Jones A; American Board of Surgery, Philadelphia, Pennsylvania., Zmijewski P; Department of Surgery, University of Alabama at Birmingham., Sarosi GA Jr; Department of Surgery, University of Florida, Gainesville., Brasel KJ; Department of Surgery, Oregon Health & Science University, Portland., Klingensmith ME; American Board of Surgery, Philadelphia, Pennsylvania.; Accreditation Council for Graduate Medical Education, Chicago, Illinois.; Department of Surgery, Washington University in St Louis, St Louis, Missouri., Minter RM; Department of Surgery, University of Wisconsin, Madison., Buyske J; American Board of Surgery, Philadelphia, Pennsylvania.; Department of Surgery, University of Pennsylvania, Philadelphia., Lindeman B; Department of Surgery, University of Alabama at Birmingham.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2024 Jul 01; Vol. 159 (7), pp. 801-808.
DOI:	10.1001/jamasurg.2024.0809
Abstrakt:	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.
Databáze:	MEDLINE
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