Feedback Quality in Geriatric Medicine: Analyzing Entrustable Professional Activities in a Competency-Based Curriculum

Abstract

Background

Competency-based medical education (CBME) aims to enhance the quality of medical training by providing timely, actionable feedback through entrustable professional activities (EPAs). However, variability in feedback quality remains a concern across residency programs.

Methods

We conducted a retrospective analysis of EPA feedback forms from a geriatric medicine program, comparing two distinct time periods: 2019–2020 and 2021–2022. This program averages eight residents per year with 30 full-time faculty members. The quality of feedback was assessed based on timeliness, task orientation, actionability, and polarity.

Results

404 EPAs were initiated and completed in 2019–2020, with 69% (n=278) being timely, 89% (n=360) task oriented, 50% (n=203) very actionable, and 62% (n=250) corrective in polarity. 851 EPAs were initiated in 2021–2022 and 76% (n=645) were completed, with 64% (n=410) being timely, 78% (n=501) task oriented, 40% (n=259) very actionable, and 47% (n=305) corrective in polarity. Timely feedback was more likely to be task-oriented (χ²(1)=11.87, p<.001), actionable (χ²(2)=24.40, p<.001), and corrective (χ²(3)=22.80, p<.001) in the second timeframe. Compared to the second timeframe, EPAs completed in the first timeframe were more likely to be task oriented (χ²(1)=22.08, p<.001), actionable (χ²(2)=25.54, p<.001), and corrective in polarity (χ²(3)=25.89, p<.001).

Conclusions

Our study revealed lower quality feedback over time since implementing CBME at a geriatric medicine subspecialty training program. The root causes of the reduction in quality were not explored but are theorized to be multifactorial. Further investigation into the reasons for the reduction in feedback quality will help direct interventions to better sustain the quality of CBME implementation.