Background: Competence by Design (CBD), a new
outcomes-based approach to medical education, has been recently introduced
into neurosurgical programs across Canada. A cornerstone of this educational
paradigm shift requires evaluation of residents’ performances of entrustable
professional activities (EPAs). This study aimed to define Faculty
expectations and markers of competence for resident EPA performances.
Methods: Canada-wide survey of neurosurgical
Faculty (NSF) with a 55-item online questionnaire referencing 15/45
available core neurosurgery EPAs. Results: Of the 52
respondents, majority believed that being able to perform safely (98%),
effectively (92%) and independently (90%) and being able to adapt to
contextual complexities of the case (88%) and unexpected events (88%)
represented necessary qualities for demonstrating competence achievement of
an EPA. Performing efficiently, without supervision and responding to rare
events were all considered less important. On average, NSF believed that at
least five separate assessments involving two or more different assessors
were necessary for documenting competence achievement of each EPA.
Proportion believing EPAs were representative of general neurosurgery
competences varied significantly across all EPAs (p<0.00001) with >25%
believing 5/15 EPAs required fellowship training.
Conclusions: This study defined expectations and
indicators of competent surgical performance and revealed a significant
debate regarding perceived appropriateness of current EPAs for general
neurosurgical training.
The Imminent Educational Paradigm Shift: How Artificial Intelligence will Reframe how we Educate the Next Generation of Engineering Designers