ImportanceA 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.ObjectiveTo identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions.Design, Setting, and ParticipantsThis 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.ExposureMicroassessments 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 MeasuresThe 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.ResultsAmong 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 RelevanceIn 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.

中文翻译：

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临床能力委员会对可委托专业活动的决策信心

重要性经过为期 2 年的可行性试点研究，美国外科委员会批准了采用可委托专业活动 (EPA) 的基于能力的评估框架。试点研究项目的临床能力委员会 (CCC) 每半年使用这一新开发的评估工具对 EPA 委托的居民进行一次评估，但与他们的决策相关的因素尚不清楚。 目的确定与 CCC 决策信心变化相关的因素EPA 终结性委托决策。设计、设置和参与者这项队列研究使用了 EPA 试点研究的去识别化数据，参与地点为 28 个普通外科住院医师项目，前瞻性收集时间为 2018 年 7 月 1 日至 2020 年 6 月 30 日。数据分析来自2022年9月27日至2023年2月15日。暴露在四个为期6个月的研究周期的常规临床护理过程中收集的试点EPA（胆囊疾病、腹股沟疝气、右下腹疼痛、创伤和咨询）住院医师委托的微观评估。然后由每个研究周期的项目 CCC 确定终结性委托评级。 主要结果和措施 主要结果是终结性委托决策的 CCC 决策信心评级（高、中、轻微或无信心），次要结果是根据终结性委托决定收到 EPA 微观评估。使用双变量检验和混合效应回归模型来评估与 CCC 信心相关的因素。结果在接受至少 1 次 EPA 微观评估的 565 名居民中，报告了 1765 项总结性委托决定。总体而言，72.5%（1765 例中的 1279 例）的终结性委托决策是在中等或高度置信度的情况下做出的。置信度随着 EPA 微观评估平均数量的增加而增加，无置信度为 1.7 (95% CI, 1.4-2.0)，有轻微置信度为 1.9 (95% CI, 1.7-2.1)，有置信度为 2.9 (95% CI, 2.6-3.2)中等置信度为 4.1（95% CI，3.8-4.4）高置信度。在控制计划效果后，EPA 微观评估数量的增加与除 1 EPA 阶段外的所有阶段的 CCC 置信度较高的可能性增加相关（比值比范围：术中 EPA-4 为 1.21 [95% CI，1.07-1.37] 至 2.93 [95%] CI，1.64-5.85]术后 EPA-2)；对于术前 EPA-3，没有关联。 结论和相关性 在这项队列研究中，随着 EPA 微观评估数量的增加，CCC 对 EPA 终结性委托决策的信心增加，并且 CCC 对大多数委托决策的信心为中等到高。这些发现为这一新颖的评估框架提供了早期有效性证据，并可能为全国范围内实施 EPA 的计划实践提供信息。