Competency-Based Cardiology Training: A Simple Approach to Improve Supervisor Completion of Entrustable Professional Activities.

Background: Adult cardiology residency programs formally transitioned to Competency by Design (CBD) in July 2021. CBD was designed to establish clear learning expectations and increase opportunities for coaching; however, cited challenges include inconsistent participation by staff, and variable timelines for receiving feedback. This project was designed to implement a simple intervention to improve expiry rates and completion timelines of entrustable professional activities (EPAs).

Methods: EPAs triggered by cardiology residents at Dalhousie University between July 1, 2020 and February 28, 2023 were reviewed. The intervention consisted of performance reviews, including a grand rounds presentation, along with a personalized data set distributed to each staff supervisor, with individual statistics compared to group averages. Outcomes include EPAs completed per resident-months, time to completion, and percentage of expired EPAs.

Results: At 12 months postintervention, the percentage of expired EPAs decreased from 35.0% to 21.5% (odds ratio 0.51, CI 0.33-0.79;  = 0.03), and the time to completion decreased from 7.3 ± 5.99 days to 5.0 ± 5.78 days (difference -2.31, CI -3.55 to -1.07; < 0.001). The number of EPAs completed per resident-months increased from 3.10 to 4.29 (rate difference 1.18; CI 0.64-1.72; < 0.001), and the percentage of EPAs completed within the target time of 48 hours increased from 54.4% to 71.5% (OR 2.11, CI 1.27-3.50;  = 0.004).

Conclusions: Performance reviews in the form of a group presentation, along with the distribution of personalized data sets to supervisors, positively impacted EPA expiry rates, completion timelines, and completion rates, which helped facilitate the transition to CBD.