472 - Medical School Graduates Perceived Core EPA Competence Before and After the COVID Pandemic: An Indicator for needed Curriculum Change

A previous investigation based on self-reported, perceived competency of core Entrustable Professional Activities (EPAs) demonstrated that the level of preparedness for interns who entered residency in 2021 may have been disrupted by the COVID pandemic. However, it remained unclear if the incoming residents’ perceived lack of competence in particular EPAs was secondary to a disruption in their clinical exposure due to the COVID pandemic or if was a result of already existing curriculum deficiencies in there undergraduate training. 

 

Objective: (1) To ascertain which of the core EPAs interns entering residency in the years 2021 and 2022 identified as needing additional training in prior to residency. (2) To compare the interns’ responses between the two years, one in which clinical exposure was curtailed and one which it was not, to identify which EPAs require more focused attention in medical school curriculum independent of the pandemic.

Design/Methods: Three months prior to orientation, interns were asked which of the 13 core EPAs they would benefit from additional training prior to residency. The survey was completed in 2021 (peak COVID disruption in training) and 2022 (COVID not a significant training issue).  EPA based responses were compared for each of the two years via chi square analysis.

Results: 35 interns were surveyed each year. They represented graduates from 24 different medical schools in 2001 and 21 in 2022. Results are presented in Table 1. The same three EPAs were of most concern to the interns in both years. These included: EPA 4 (enter & discuss orders) [97%, 85%], EPA 10 (recognize a patient requiring emergent care) [82%, 58%] and EPA 12 (procedures) [74%, 64%]. EPAs which demonstrated a statistical decline in concern between the two years included: EPA 2 (prioritize differential) [59%, 27%], EPA 6 (oral presentation) [35%, 6%], EPA 7 (form a clinical question) [50%, 27%], EPA 9 (collaboration) [21%, 3%] and EPA 13 (identify system errors) [62%, 6%].

Conclusion(s): The interns’ self-reported competency in certain EPAs (2,6,7,9,13) seems to be based on their clinical exposure. Competency in other EPAs (4,10,12) seems to be independent of clinical exposure. Although this is a single institution's experience, our interns came from a diverse group of schools. This suggests that medical schools should develop a focused curriculum to enhance preparation for residency for specific EPAs which cannot be obtained through traditional clinical experiences. Until this change is realized, Program directors need to be aware and be prepared to address these gaps in their incoming intern's education.