Challenges, Reliability, and Implementation Frameworks of Entrustable Professional Activities in Postgraduate Surgical Training: A Scoping Review

Abstract

Background: Entrustable Professional Activities (EPAs) have become part and parcel of competency-based medical education, used to provide a structured framework to assess a resident's readiness to practice independently. Their application to postgraduate surgical education has grown but findings regarding their implementation, assessment, reliability and educational impact are still varied. Objective: To review, visualize and integrate the existing literature regarding implementation, evaluation, reliability and development of EPAs in postgraduate surgical education. Methods: A scoping review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Scopus, Web of Science, ScienceDirect and Cochrane Library databases were searched electronically. Eligibility criteria were pre-established and then studies were screened. Thematic descriptive synthesis was used for data synthesis, while a full-text article was coded using the Taguette qualitative analysis software. Results: Twenty studies were included in the eligibility criteria. Five themes emerged: implementation models, approaches to entrustment decision making, approaches to reliability and validity evidence, barriers and facilitators to implementation, and framework development and future directions. EPAs were frequently incorporated into workplace assessment systems and facilitated the gradual increase of resident independence. Assessor variations, documentation requirements, inconsistencies in entrustment and limited standardization were reported issues. Key factors for successful implementation were faculty development, institutional support, and integration in competency-based curricula. Conclusion: EPAs are a promising tool to assess competency in postgraduate surgical education. Multiple centers and follow-up studies are required to standardize implementation, establish assessment reliability, and validate long-term educational outcomes in a variety of surgical training environments.