Non-core entrustable professional activities (EPAs) assessments enhance understanding of resident entrustment progression

Abstract Purpose Although the American Board of Surgery established 18 core general surgery entrustable professional activities (EPAs), procedures not included in the core list (non-core EPAs) comprise a substantial portion of residents’ case volumes at quaternary referral centers. Comparing core and non-core EPAs may help to better characterize resident progression and preparation for fellowship training. Methods We retrospectively analyzed EPA assessment data from a large quaternary referral center. Faculty completed assessments for the 18 core EPAs and used a “non-core” category for procedures not included in that list. Assessments were stratified by postgraduate year (PGY) to assess completion across training levels. A mixed-effects linear regression model compared entrustment-supervision (ES) scores (1 = observation to 4 = practice ready) between core and non-core assessments, accounting for individual resident performance. Results Between June 2022 and July 2024, we collected 1135 core and 558 non-core EPA assessments. Senior residents completed more non-core EPA assessments, with PGY5 residents completing the most (PGY1: 43; PGY2: 141; PGY3: 115; PGY4: 64; PGY5: 235).The most common non-core procedures were pancreatectomy ( n = 74), gastrectomy ( n = 67), ostomy reversal ( n = 60), pediatric central line ( n = 52), and hepatectomy ( n = 45). Mixed-effects modeling showed that ES scores were significantly higher for core EPAs ( F = 9.37, p < 0.01). PGY level significantly predicted ES scores ( F = 279.45, p < 0.001), and only a small proportion of score variability (variance = 0.05) was attributable to resident differences. Conclusions Non-core EPAs reflect complex operations with lower entrustment levels. Non-core EPAs provide clarity on the progression of entrustment as case complexity increases. Incorporating non-core EPA assessments may enhance assessment of senior residents.