Análise da implantação da avaliação baseada em atividades profissionais confiáveis na residência médica de cirurgia geral do Hospital Universitário Alzira Velano

Abstract

Introduction: In surgical education, evaluating learners' competencies while ensuring patient safety is a significant challenge. However, a competency assessment system based on entrustment levels assigned for Entrustable Professional Activities (EPAs) can help overcome this challenge. This study aimed to analyze the implementation of such a system in the general surgery residency program at Alzira Velano University Hospital in Alfenas, Minas Gerais. Methods: This descriptive study conducted a cross-sectional analysis of residents' and preceptors' perceptions of this new assessment framework. The implementation process and residents' performance were described by analyzing academic records. The perceptions of residents and preceptors were analyzed using an online questionnaire administered at the end of the process. Data collection occurred between May and July 2023. Results: It is evident that residents and preceptors widely accepted competency-based medical assessment in the program; the study period involved 110 resident evaluations, averaging 18.3 evaluations per resident. The Clinical Competence Committee (CCC) assigned the entrustment levels by both R1 residents in the postoperative EPA and one R2 resident in the preoperative EPA, while the remaining evaluated residents did not reach the expected levels in the assessed EPAs. The remaining evaluated residents did not reach the expected levels in the assessed EPAs. Due to the significant competency gaps identified and described, implementing competency-based medical assessment in the long term requires commitment from preceptors, residents, and the institution. Nonetheless, the perception questionnaire analysis showed widespread acceptance of the assessment method, which is well-presented, easily understood, fair, and valuable in promoting feedback and learning. All preceptors affirmed that the process was transparent and fair, although 37.5% reported difficulty conducting the evaluations. Among residents, all considered the method an excellent overall performance evaluation tool and helpful in providing feedback, although 16.7% partially disagreed with the entrustment level assigned by the CCC. Conclusion: Our program has found that residents and preceptors widely accept competency based medical assessment. This evaluation provides a more comprehensive view of a resident's abilities and offers consistent and accurate feedback. However, it is essential to note that full implementation of this approach is a long-term process that requires consistent commitment from preceptors, residents, and the institution.