Competency-based medical education frameworks are transforming surgical training, but existing assessment tools may not detect incremental intraoperative skill acquisition in junior residents. To provide a granular assessment of progressive skill acquisition, we developed 10 nested Entrustable Professional Activities (EPAs), discrete surgical tasks embedded within American Board of Surgery core 18 General Surgery EPAs. We hypothesized that residents would earn higher entrustment scores on nested EPAs than core EPAs, reflecting earlier detection of operative competency. We conducted a single-center retrospective analysis of core and nested EPA assessments for all clinical general surgery residents during two academic years (June 2024–June 2026). EPAs were evaluated on the ABS 4-point entrustment-supervision scale. Residents were grouped by clinical year (PGY1–5). Median core and nested EPA scores were compared using the Wilcoxon signed-rank test, with secondary analysis examining paired median differences (nested minus core scores). Sixty-eight residents had 1811 and 161 assessments for core EPAs and nested EPAs, respectively. Nested EPA scores demonstrated an earlier upward trajectory and increased over each year increment from PGY1 to PGY4, whereas core EPA scores only increased between PGY2–PGY3 and PGY4–PGY5. Paired median nested EPA scores exceeded core EPA scores for PGY1–4, with significant differences at PGY1 (p = 0.016) and PGY4 (p = 0.046). Nested EPAs capture earlier intraoperative progression than core EPAs, particularly for junior trainees. As a complement to existing competency-based assessment frameworks, nested EPAs may facilitate earlier identification of trainees needing additional support while providing residents with meaningful markers of operative progress.
Trauma care in resource limited settings vary due to differences in conditions and there is opportunity to create strategies that support pre-hospital emergency workers. However this is hindered by interconnected challenges spanning the entire continuum of care, from injury recognition and prehospital response to hospital management, rehabilitation, and system governance. Addressing these barriers requires strengthening prehospital emergency medical services, developing coordinated trauma systems, investing in workforce and infrastructure, improving financing mechanisms, and prioritizing injury prevention. Incremental, evidence-based improvements tailored to local contexts have the potential to significantly reduce preventable deaths and disability, particularly in rapidly urbanizing LMICs.
Surgery faces a well-being crisis, with rates of altered mental health rising during residency. While experience of recent error correlates with measures of poor well-being, the mechanisms are unclear. Shame, a global negative self-assessment, offers a novel lens for understanding these experiences. From July - November 2025, 12 general surgery residents were recruited using convenience, snowball, and purposive sampling. Participants completed a written reflection on their experiences of shame and a one-hour semi-structured interview exploring these experiences. Data were analyzed using hermeneutic phenomenology to produce a rich description of surgical residents’ shame experiences following error. Technical, judgment, normative, and quasi-normative errors were observed as triggers of shame. Shame was immediate, intense, and debilitating, with global self-assessments of inadequacy present across all error types. The specific dimension of the self that was implicated in shame varied by error. The trajectory of shame was shaped by community engagement, with formal mechanisms like M M available for technical and judgment errors and informal channels bearing the burden for normative and quasi-normative errors. Errors during surgical training are identity-relevant experiences triggering shame in ways varying by error type. Technical errors threaten skill, judgment errors threaten reasoning, normative errors threaten character, and quasi-normative errors threaten belonging. Crucially, shame and its trajectory are not inevitable. They are both shaped by culture and community engagement. Programs providing constructive feedback, reflection, psychological safety, and learning-focused responses enable residents to grow from error rather than be defined by it.
Assessments of technical skills are a central component of competency-based medical education (CBME) programs. However, such assessments may impede trainees’ performance, as studies have shown that cognitive load influence technical skills. Yet little is known about the influence of supervision on cognitive load. As such, the purpose of this paper is to investigate if assessment affect performance of surgical skills and if so, how this is mediated by cognitive capacity. An experimental crossover-study design was used to compare the effects of supervisor assessment vs no assessment. Surgical residents performed a suturing exercise on three consecutive days, and technical skills (OSATS) and cognitive load (NASA-TLX) were recorded. Supervisor assessment was conducted on either Day 2 (Group 1) or Day 3 (Group 2), with an alternate no assessment condition. At baseline, no significant differences in OSATS or NASA-TLX scores were observed between groups. A significant difference in OSATS score on day 2 and 3, with Group 1 outperforming Group 2 on both days (day 2: M − 4.8 95
Previous work found an informed consent curriculum and corresponding novel formative assessment tool for graduating fourth-year medical students preparing for a surgical-based residency to be effective based on student-performance and end-of-course-survey data. However, students underperformed on certain skills indicating the opportunity for refinement of the assessment tool. This study aims to identify and refine areas of the assessment tool used in the informed consent curriculum. A total of 325 medical students across two-academic years (22–23, 23–24) received an informed consent curriculum. Students practiced a specialty-specific informed consent encounter with a standardized-patient (SP). Student performance was rated by the SP using a 22-line-item communication skills tool, using a defined rubric (scale 0, 1, 2) for each skill. SP-rated student performance data were tallied for each line-item. Student performance data was analyzed using an exploratory factor analysis (principal axis factoring with Promax rotation) and internal reliability test with IBM SPSS Version 30 statistical package. Exploratory factor analysis was conducted on 22 communication skills. Sampling adequacy was acceptable (KMO = 0.66; Bartlett’s χ2(231) = 968.27, p < .001). The scree plot indicated retention of approximately three factors, and the initial eigenvalue criterion yielded eight factors explaining 34.8
