Development of Entrustable Professional Activities for Complex General Surgical Oncology

Background: Entrustable professional activities (EPAs) are familiar to academic surgeons since their adoption by the American Board of Surgery in 2023. Complex general surgical oncology (CGSO) fellowships have been required to adopt EPAs as part of the goal of competency-based education. This report describes the results from the initial creation of an EPA set for CGSO. Methods: Three separate groups are involved in the creation of an EPA set. The first group is the oversight group or “owner” of the process. This group takes responsibility for defining the need and for final approval of the EPA set. In the reported case, the CGSO Board comprised this group. The second group defines the EPA set, defines the scope of each, and provides direct oversight of the writing process. A group of senior volunteers assumed this task. The third group performed the detailed writing and included the attending surgeons as well as the surgical residents and CGSO fellows. Results: To encompass the core of surgical oncology, 12 EPA topics were selected. To these EPAs were mapped 19 of 23 CGSO milestones to provide clinically applicable assessment tools for the majority of the milestones. Discussion: Creation of an EPA set for CGSO entailed several challenges described in this report. The methods used by the authors are described in detail to serve as a potential template for other specialties. Because most individuals will have only one opportunity to develop similar programs, the authors present their experience with the hope that it will be useful to others as they embark on creation of EPAs for their own specialty.