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Background Entrustable Professional Activities (EPAs) contain narrative ‘entrustment roadmaps’ designed to describe specific behaviors associated with different entrustment levels. However, these roadmaps were created using expert committee consensus, with little data available for guidance. Analysis of actual EPA assessment narrative comments using natural language processing may enhance our understanding of resident entrustment in actual practice. Methods All text comments associated with EPA microassessments at a single institution were combined. EPA—entrustment level pairs (e.g. Gallbladder Disease—Level 1) were identified as documents. Latent Dirichlet Allocation (LDA), a common machine learning algorithm, was used to identify latent topics in the documents associated with a single EPA. These topics were then reviewed for interpretability by human raters. Results Over 18 months, 1015 faculty EPA microassessments were collected from 64 faculty for 80 residents. LDA analysis identified topics that mapped 1:1 to EPA entrustment levels (Gammas >0.99). These LDA topics appeared to trend coherently with entrustment levels (words demonstrating high entrustment were consistently found in high entrustment topics, word demonstrating low entrustment were found in low entrustment topics). Conclusions LDA is capable of identifying topics relevant to progressive surgical entrustment and autonomy in EPA comments. These topics provide insight into key behaviors that drive different level of resident autonomy and may allow for data-driven revision of EPA entrustment maps.

Background Longitudinal contact between faculty and residents facilitates greater faculty entrustment. The purpose of this study is to assess the relationship between faculty familiarity with residents and faculty entrustment. Materials and methods Researchers observed and rated entrustment behaviors using OpTrust, September 2015–June 2017 at Michigan Medicine. Faculty familiarity with resident was measured on a 1–4 scale (1 = not familiar, 4 = extremely familiar). ANOVA and Sidak adjusted multiple comparisons were used to assess the relationship between faculty familiarity and faculty entrustment. Results 56 faculty and 73 residents were observed across 225 surgical cases. Faculty entrustment scores increased to 2.48 when resident familiarity was reported as “slightly familiar”. Faculty entrustment scores for “moderately familiar” increased to 2.57. Faculty entrustment scores for “extremely familiar” increased to 2.84. Conclusions We found a positive relationship between faculty familiarity and entrustment. These findings support greater continuity in faculty/resident relationships. Longitudinal contact allows learners to be granted progressive entrustment. Summary This study demonstrates a positive relationship between faculty familiarity with residents and an increase in intraoperative entrustment. These findings support greater continuity in faculty/resident relationships.

Faculty entrustment decisions affect resident entrustability behaviors and surgical autonomy. The relationship between entrustability and autonomy is not well understood. This pilot study explores that relationship.108 case observations were completed. Entrustment behaviors were rated using OpTrust. Residents completed a Zwisch self-assessment to measure surgical autonomy. Resident perceived autonomy was collected for 67 cases used for this pilot study.Full entrustability was observed in 5 of the 108 observed cases. Residents in our study did not report full autonomy. Spearman's rank correlation coefficient identified that resident entrustability was positively correlated with perceived resident autonomy (ρ = 0.66, p 0.05). Ordinal logistic regression assessed the relationship between resident entrustability and autonomy. The relationship persisted while controlling for PGY level, gender, and case complexity (OR = 8.42, SEM = 4.54, p 0.000).Resident entrustability is positively associated with perceived autonomy, yet full entrustability is not translating to the perception of full autonomy for residents.

In the present study, ‘‘Using Spaced Education to Teach Interns About Teaching Skills,’’ Pernar et al investigated the use of electronic distribution of content to interns with succinct teaching pearls on a weekly basis. Although the study was underpowered and focused on 3 distinct teaching skillsdeffective delivery of feedback, teaching and learning principles, and dissemination of core clerkship content to studentsdit provides evidence that a strategy of spaced education may be an effective approach for efficiently delivering this material to interns and engaging them in the teaching process. Given the expectation of the Liaison Committee on Medical Education that we provide our residents with formal training in teaching, coupled with a significant reduction in postgraduate year 1 duty hours, an approach such as that described in this study is very appealing. In this era of less time for interns to both receive content and to participate in teaching activities, a focus on just-in-time teaching skills is critical, and the described spaced education technique allows an emphasis on this approach and minimizes the time required to deliver the content to interns. Pedagogically, the approach of distributed practice in delivering the feedback and learning pearls and reminders to teach weekly is also sound. Although we typically think of the importance of distributed practice for technical skills acquisition, this concept almost certainly applies here as well. Delivery of content and teaching tips in small ‘‘digestible chunks’’ allows interns to better incorporate these skills by practicing them regularly. This approach is

Operative anatomy; Surgical education; Preparatory curricula; Surgical training; Medical students; Internship Abstract BACKGROUND: An operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members. METHODS: Senior medical students performed intern-level procedures on cadavers with the assis- tance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both col- lectively and based on individual procedures. RESULTS: Student confidence and procedural knowledge significantly increased and anxiety signif- icantly decreased when preoperative and postoperative data were compared (P , .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks. CONCLUSIONS: The consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency.

Background This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress. Methods Fourteen surgery interns were randomized into 2 groups. The intervention group received task-specific proficiency criteria to guide practice. The control group did not. After training, participants were evaluated by blinded faculty during laparoscopic cholecystectomy. Results The control group met significantly fewer of the 7 LapSim (Surgical Science Sweden AB, Goteborg) targets (mean = 1.14) than the intervention group (mean = 7.00; P = .001) and significantly fewer of the 5 video trainer targets (mean = .86) than the intervention group (mean = 5.00; P = .001). Ratings of depth perception, bimanual dexterity, efficiency, tissue handling, autonomy, and overall competence were higher for the intervention group. Effect sizes ranged from medium to large (.394–.981), indicating an impact of the proficiency-based training protocol. Conclusions Delineation of proficiency targets with reporting of progress improves interns' practice results, and appears to have a positive effect on their early operating room (OR) performance of laparoscopic cholecystectomy.

Background No universally accepted method to measure professionalism exists. We developed an instrument to measure specific aspects of professionalism in surgical residents. Methods Professionalism was deconstructed into 15 domains. Behavioral descriptors were determined for extreme and selected intermediate anchors. It became evident that residents could “go too far” in some professional behaviors. Therefore, although a 7-point continuous ordinal scale forms the framework, a score of 7 does not necessarily indicate the ideal. This characteristic minimizes the problem of inflated ratings. Results The instrument was utilized by attending faculty to evaluate residents and also by residents as a self-evaluation. Calculated from ordinal values, mean (SD) of the ratings across domains for faculty evaluations of residents was 4.95 (0.38) while mean for self-evaluations was 4.95 (0.39). Reliability was high (coefficient alpha 0.85). Conclusions This instrument provides a means to measure professional behaviors during surgical residency. Repeated use will be required to thoroughly establish validity and reliability.

Despite equivalent performance as assessed by objective external measures, women tend to underestimate their abilities compared with their male counterparts.The difference in ordinal values from faculty and resident self-evaluations was calculated for each general and plastic surgery resident. Objective external performance measures were compared for female and male residents.Male and female residents performed equivalently. All residents underestimated their abilities compared with faculty assessment; however, general surgery residents did so to a greater degree (P.05). Female residents demonstrated a greater degree of underestimation than did their male colleagues; however, this was not statistically significant.Although female resident surgeons are generally confident in their abilities, this may be in contrast to the self-perception of many female medical students. Consideration of gender differences in self-perception may be important when providing feedback to female students and residents.