Comparing High and Low Faculty EPA Assessment Completers: Insights to Improve EPA Implementation

COMPARING HIGH AND LOW FACULTY EPA ASSESSMENT COMPLETERS: Insights to Improve EPA Implementation OBJECTIVE: Despite the widespread use of Entrustable Professional Activities (EPA) assessments, faculty completion rates vary significantly. Understanding the motivations behind faculty participation is crucial for improving these rates. Utilizing the Theory of Planned Behavior (TPB), this study explores the factors influencing EPA assessment completion by examining high- and low-completing faculty. DESIGN: Using EPA assessments from 2023-2024, we calculated the percentage of assessments completed to total resident cases generated from resident case logs. Faculty were classified as high-users (at or above the median EPA assessments-to-case percentage) or low-users (below the median). Participants completed 15-minute semi-structured Zoom interviews. Qualitative codes were generated deductively from the transcripts guided by the TPB looking for intention to complete assessments based on their attitude, who influences their behavior (subjective norm), and perceived control of their behavior. We also inductively identified codes. Using a directed content analysis we identified themes. SETTING: Three institutions affiliated with a single general surgery residency program: a large academic quaternary referral center, a private community hospital, and a major Health Maintenance Organization (HMO) hospital PARTICIPANTS: Seventy-seven surgical faculty participated in EPA assessments, with a median completion rate of 4.32% of total resident cases (range: 0.43%-100%). RESULTS: Interviews with 15 faculty members (9 high-users, 6 low-users) revealed differences in attitudes towards EPA assessments and perceived behavioral control. Both groups agreed on the influence of subjective norms, the importance of feedback quality, and incongruency between the Entrustment-Supervision (ES) scale and surgical training. High users were more confident in the value of EPA assessments and integrated them into their workflow. Low users, however, were uncertain of the impact and preferred residents to initiate assessments. CONCLUSIONS: To increase faculty participation, targeted development programs should clarify the benefits of EPA assessments, streamline their integration into clinical workflows, and address challenges with the ES scale.