Faculty and resident perceptions/judgments of Entrustable Professional Activities (EPA) performance in the context of Ethiopian medical education

Background: Entrustable Professional Activities (EPAs) are units of professional practice that are defined as tasks or responsibilities that are entrusted to an unsupervised execution by a trainee. In 2021, a framework of 29 EPAs was developed for surgical residency training programs in Ethiopia. The goal is that graduating surgical residents being able to perform independently by the time they graduate. However, residents' ability to carry out EPAs is being questioned. The objective of this study is to assess how faculty members judge residents' performance in executing these EPAs, as well as how residents rate their own ability. The study builds on previous work that developed EPAs for surgical residency training, making it relevant to systematically introduce and implement EPAs. Methods: : A survey was conducted in the Departments of Surgery at four residency training institutions in Ethiopia from June 21 to August 21, 2021. All eligible faculty members and final-year general surgery residents were invited to participate in the study. Surgical team members were asked to judge performance of residents, and residents were asked to rate their own capability in executing EPAs. The analysis focused on variations in performance ratings between surgical team members and residents, as well as across faculty members. Results: A total of 125 surgical team members and 49 graduating general surgery residents participated in this study. Residents rate their competence in performing these EPAs higher than surgical team members (mean 4.2 (SD = 0.63) vs. 3.7 (SD = 0.9). A statistically significant difference was observed between the two groups of study on the overall mean rating of resident performance (combined dependent variables) (P =0.03, CI: 0.51-0.95), as well as within surgical faculty members (P < 0.001). Conclusions: : In executing EPAs, there was disagreement between the residents' and surgical team members' judgment, as well as among faculty members. Faculty expected residents to still require supervision in these EPAs. This suggest that the programs may produce graduating residents who are ill prepared for independent practice. The perception/judgment gap that exists between residents and surgical teams and among faculty members could pose a problem in education.