Evaluation of Entrustable Professional Activities Implemented in Australian General Surgical Training: Perspectives of Surgeons and Trainees

• In Australian General Surgical Training, Entrustable Professional Activities (EPAs) have been implemented with mixed results. • IT platform and functionality are critical to realtime and effective use of EPAs. • EPAs have helped create shared learning goals between Surgeons and Trainees, but fall short of changing entrustment decision-making. • Selective behaviors of trainees can limit the actual use of EPAs. In 2022 the General Surgical Education and Training program was implemented in Australia with a focus on competency-based medical education. This program utilized entrustable professional activities (EPAs) to provide a framework for teaching and assessing competencies. To investigate the implementation of EPAs in the General Surgical Education and Training program, interviews were conducted with both surgeons and trainees across Australia. Inductive thematic analysis was used to analyze interviews and synthesized into the Technology Acceptance Model. Ten surgeons and 10 trainees were interviewed across Australia. Thirteen major themes were identified. Overall, EPAs were perceived as easy to use, with suggestions to improve functionality. Surgeons and trainees perceived their usefulness as creating a shared learning model, whilst educational and assessment value was lacking. Attitudes towards their use could be characterized as “tick-box tasks.” Actual use was retrospective, reflecting only a narrow spectrum of operative cases. Assessment was often irrespective of a trainees performance, and comment boxes were not filled in. The implementation of EPAs in Australian general surgical training has had both intended and unintended implications. Improving the ease of use, and perceived usefulness of these tools for surgeons and trainees will improve attitudes towards use, and help align the intended and actual use.