What motivates general surgery residents to request entrustable professional activity assessments? A qualitative study

Abstract Purpose We explored residents’ motivations for requesting entrustable professional activities (EPA) assessments, specifically examining how these motivations are influenced by the fulfillment of the basic psychological needs of autonomy, competence, and relatedness, as outlined in self-determination theory (SDT). Methods We categorized residents from a single general surgery residency program as high (≥ median) or low (< median) EPA users based on median EPA assessment counts from June 2023 to June 2024. We then conducted semi-structured interviews with residents. Using directed content analysis, we deductively applied codes derived from SDT principles and inductively developed new codes for thematic analysis. Results We conducted 17 interviews (10 high and 7 low users). We did not identify any differences in motivation between user groups. Both external influences (faculty roles, program requirements) and residents’ psychological needs for autonomy, competence, and relatedness affected EPA assessment requests. Residents’ conflicting perception of EPA assessments’ utility as a learning tool impacted their willingness to seek assessments autonomously. While a desire for competence encouraged initiation, the fear of perceived incompetence often deterred residents from requesting assessments. Lastly, relatedness factors, such as relationship with faculty and comparison of completion rates among peers, had varying effects. Conclusion These findings suggest that aligning EPA implementation with residents’ psychological needs can foster more meaningful engagement. Programs may shift the assessment process from a checkbox task to learner-driven growth.