EQual Rubric Evaluation of the Radiation Oncology Education Collaborative Study Group Entrustable Professional Activities

• Published in: International journal of radiation oncology, biology, physics Vol. 123; no. 1; p. e3
• Main Authors: Wagner, Brett, Braunstein, Steve, Brisson, Ryan, De Leo, Alexandra, Garda, Allison, Gunther, Jillian, Henson, Christina, Hirsch, Ariel E, Holmes, Jordan, Katz, Leah, Mattes, Malcolm, Schuster, Jessica Moore, Price, Jeremy, Shiue, Kevin, Thomas, Horatio, Golden, Daniel W.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2025
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2025.05.023

In recent decades, graduate medical education has been considering a shift from time-based to competency-based training. Entrustable Professional Activities (EPAs) have emerged as structured tools to translate competency-based education into clinical practice by defining discrete, assessable tasks that residents must be able to perform independently. In 2023, the Radiation Oncology Education Collaborative Study Group (ROECSG) systematically developed 52 EPAs to establish a competency-based framework for United States radiation oncology residency training (Jeans et al. (2023)). This study aims to rigorously evaluate the ROECSG EPAs for inherent quality using the previously published EQual rubric. An electronic survey was distributed to subject-matter experts, including attending radiation oncologists at academic medical centers (teaching faculty) and senior residents. The survey utilized the EQual rubric, a published EPA assessment tool comprising 13 items rated on a 1-5 Likert-type scale. These items evaluated the discreteness, importance to the profession, and educational utility of each EPA. Participants were asked if an EPA required revision and, if so, to provide specific recommendations for modification. Descriptive statistics were calculated and EPAs with a mean score below 4.07, a threshold previously established using the Anghoff method, were identified for revision. Results are reported as EPA mean rating ± standard deviation. 14/17 (82.4%) participants completed the survey including 13 radiation oncology teaching faculty and one senior resident. 4/13 (30.8%) were program directors and 5/13 (38.5%) were associate program directors. The mean EQual rating for all EPAs was 4.39 ± 0.30. 7/52 (13.5%) EPAs scored below the cutoff of 4.07 including EPA2 (3.65 ± 0.53), 7 (3.97 ± 0.73), 18 (3.77 ± 0.68), 19 (3.56 ± 0.77), 34 (4.06 ± 0.70), 43 (3.81 ± 0.74), and 47 (3.76 ± 0.76). An additional 12/52 EPAs scored within one standard deviation of the cutoff. Overall, 45 of the proposed EPAs were rated as high quality, and seven EPAs were identified that require revision. To ensure that the assessment of radiation oncology residents reflects the diverse competencies of the profession, further refinement and systematic implementation of these revisions are necessary. Ongoing evaluation and refinement of the ROECSG EPAs will be essential to adapt to the evolving landscape of radiation oncology.