Defining activities in neurovascular microsurgery training: entrustable professional activities for vascular neurosurgery

Abstract

Background: Entrustable professional activities (EPAs) represent an assessment framework with an increased focus on competency-based assessment. Originally developed and adopted for undergraduate medical education, concerns over resident ability to practice effectively after graduation have led to its implementation in residency training but yet not in vascular neurosurgery. Subjective assessment of resident or fellow performance can be problematic, and thus, we aim to define core EPAs for neurosurgical vascular training.

Methods: We used a nominal group technique in a multistep interaction between a team of experienced neurovascular specialists and a medical educator to identify relevant EPAs. Panel members provided feedback on the EPAs until they reached consent.

Results: The process produced seven core procedural EPAs for vascular residency and fellowship training, non-complex aneurysm surgery, complex aneurysm surgery, bypass surgery, arteriovenous malformation resection, spinal dural fistula surgery, perioperative management, and clinical decision-making.

Conclusion: These seven EPAs for vascular neurosurgical training may support and guide the neurosurgical society in the development and implementation of EPAs as an evaluation tool and incorporate entrustment decisions in their training programs.

Keywords: Assessment; Competency-based education; Entrustable professional activities; Patient care; Practice-based learning and improvement; Vascular neurosurgery.

Fig. 1

Non-complex aneurysm surgery

Fig. 2

Complex aneurysm surgery

Fig. 3

Bypass surgery

Fig. 4

Arteriovenous malformation resection

Fig. 5

Spinal dural fistula

Fig. 6

Perioperative management

Fig. 7

Clinical decision-making