Association for Academic Surgery (AAS)

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Entrustable Professional Activities for Research: Are EPARs on the horizon?

Entrustable professional activities (EPAs) have become an increasingly important metric over the past decade regarding clinical training for residents and fellows. EPAs aggregate competencies for clinical activities, such as surgical procedures like inguinal hernia repair, and apply a holistic method to assess a trainee’s ability to practice independently. Numerical scoring from 0 (observation only) to 4 (supervising others) is often applied. Currently, EPAs encompass topics ranging from management of gallbladder disease to trauma evaluation, and they focus on various stages of clinical care (e.g., preoperative, intraoperative, postoperative, and consults).1 In the future, assessments via EPAs may influence how quickly trainees progress through their training to become independently functioning, board-certified surgeons.

Much like with an inguinal hernia repair, a core skill set exists that trainees need to develop for productive basic science, translational, or health services research experiences. However, relatively little attention has been paid to research skill assessment. This is surprising given that more than 70% of surgical residents publish manuscripts during residency, and many will eventually lead research groups as faculty members.2 Below, we discuss four categories that encompass foundational skills that trainees need to acquire and receive feedback on during their research training experiences.

  1. Generating a Research Question

This seems like a simple step, but it requires broad knowledge about a topic, familiarity with the literature, an evidence gap, and the ability of science to answer that question.

Dr. Murtha – My research question development has evolved over my time as a NIH T-32 trainee. Initially, this was frustrating because I felt like things were moving more slowly than expected. I have learned that this is part of the research process and ultimately the most important thing is to identify an impactful, answerable question. It may take some time to get there, and that’s OK.

  1. Study Design and Research Execution

Experimental methodology should be grounded in prior research, justifiable to reviewers, and replicable. Most importantly, it needs to be able to answer the research question. For example, an observation study will not answer questions about causation, for which you typically need a prospective RCT. Involvement in study design and execution ranges from patient recruitment for clinical trials to conducting basic science lab work.

Dr. Murtha – Our research group has strong statistical support, so my job is to set up the study design and frame the variables of interest. In one of our projects, we are using machine learning methods to predict weight gain in young adults from electronic health record data. Dr. Funk and I regularly discuss my role in the project, such as determining the study population and electronic heath record variables to include. This feedback helped me understand where I fit in the study team and how I can help the project progress from a concept to output such as a neural network.

  1. Publishing and Disseminating the Research

Getting a manuscript published requires more than an engaging topic and clear scientific writing. Other factors such as identification of a target journal, manuscript submission logistics, and communication with co-authors are essential. Dissemination requires proactively identifying conferences for abstract submission, networking, and potentially engaging on social media platforms like Twitter.

Dr. Murtha – The COVID-19 pandemic has mostly changed my conference presentation experience from an in-person to a virtual format. From feedback from Dr. Funk, I have learned that I present too quickly and have a harder time with eye contact in the virtual format. I also learned that I typically underestimate how long it takes to progress from circulating a manuscript to coauthors to submitting it. Dr. Funk assured me during our feedback sessions that the process is always slower than you feel it should be, and that’s OK.

  1. Project Management and Communication

Learning how to manage a research team is essential as trainees progress through their research experience. Skills such as communicating “To Do” items to team members, keeping a decision-log, and circulating research agendas to the team in a timely manner are important to learn. Documentation of the study decisions needs to be available as team members transition on and off the team. Managing authorship expectations and other issues that drift into a human resources realm (e.g., a team member falling behind on a task) are also key skills to acquire. Clear and prompt communication and follow-through on assigned tasks in a timely manner is strongly encouraged.

Dr. Funk – This is one of the most important assessment areas. Trainees are not explicitly taught how to deal with these issues, and some of these challenges will need to be handled by the PI. However, trainees need feedback on how to handle team management and leadership topics in a timely, direct, and honest manner so they are not blindsided as faculty members.

Regardless of whether research performance feedback is provided via an EPA-like app or more traditional periodic discussions, it is essential to provide this feedback regularly. Formalizing this process will help ensure both the faculty member and trainee have an avenue to identify areas of strength and those that need some attention. It would also allow longitudinal assessment of the trainee research experience and help mentors identify where trainees need help to realize their goals as independent investigators.

REFERENCES

  1. Stahl CC, Collins E, Jung SA, et al. Implementation of Entrustable Professional Activities into a General Surgery Residency. Journal of Surgical Education. 2020;77(4):739-748.
  2. Holtestaul T, Jones I, Colburn Z, et al. Publication Productivity and Bibliometric Profiling of Graduating General Surgery Chief Residents. JAMA Surgery. 2021.

 

Jacqueline Murtha, MD, MPH

Jacqueline Murtha, MD, MPH

Dr. Murtha is a general surgery resident at the University of Wisconsin-Madison. She has completed two years of clinical training and is starting her second year of research as part of an NIH T-32 post-doctorate research fellowship. She completed medical school at the University of Rochester and her MPH at the University of Georgia. Her research interests lie in addressing disparities in access to care, particularly pertaining to obesity treatment access and outcomes. She is also involved in patient care quality improvement efforts.
Jacqueline Murtha, MD, MPH

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Luke Funk

Luke Funk

Luke Funk MD, MPH is an Associate Professor of Surgery at the University of Wisconsin-Madison and Chief of the Section of General Surgery at the William S. Middleton Veterans Memorial Hospital. He is also the Director of MIS Research in the Department of Surgery at UW-Madison and Associate Program Director of the MIS fellowship. His research program is focused on optimizing access and outcomes to obesity treatment. Twitter: @lmfunk2