Characterizing narrative feedback and predictors of feedback content on an entrustable professional activity (EPA) assessment tool

Abstract

Abstract Purpose Although EPA assessment tools generally allow for narrative feedback, limited data exist defining characteristics and predictors of such feedback. We explored narrative feedback characteristics and their associations with entrustment, case-specific variables, and faculty/trainee characteristics. Methods Our general surgery residency piloted an intraoperative Entrustable Professional Activities (EPA) assessment tool in 2022. The tool included an entrustment score, four sub-scores, and narrative feedback. Given strong intercorrelations (r = 0.45–0.69) and high reliability (α = 0.84) between sub-scores, we summed the four sub-scores into a composite score. We coded narrative feedback for valence (reinforcing vs constructive), specificity (specific vs general), appreciation (recognizing or rewarding trainee), coaching (offering a better way to do something), and evaluation (assessing against set of standards). Multivariable regression analyzed associations between feedback characteristics and entrustment score, composite score, PGY level, case difficulty, trainee/faculty gender, gender matching, faculty years in practice, faculty case volume with trainees, faculty evaluation score, and trainees’ under-represented in medicine (URiM) status. Results Forty-six faculty completed 325 intraoperative EPA assessments for 44 trainees. Narrative feedback had high valence (82%) and specificity (80%). Comments frequently contained appreciation (89%); coaching (51%) and evaluation (38%) were less common. We found that faculty gender, trainee gender, and gender match predicted feedback characteristics. Generally, entrustment level, composite score, and PGY level correlated with feedback types (Table). Conclusion Entrustment and performance relate to the type of feedback received. Gender and gender match resulted in different types of feedback. Evaluative feedback was the least prevalent and warrants further exploration since evaluation is critical for learning.