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Objective <p>Entrustable professional activities (EPAs) are now required for general surgery residency assessment, typically through the SIMPL platform, but adoption has been limited by inconsistent engagement. We evaluated whether a structured re-engagement strategy guided by the ADKAR change-management framework increased EPA assessment activity.</p> Design <p>Single-center before-after quality-improvement study reported per SQUIRE 2.0. A faculty survey mapped barriers to ADKAR domains and informed a multicomponent intervention (faculty and resident re-education, a monthly leaderboard, and recognition of high participation) delivered from August to December 2024. EPA activity was compared between matched calendar quarters before (January to March 2024) and after (January to March 2025) the intervention, using count-data regression adjusted for postgraduate year and resident type and accounting for residents present in both periods.</p> Setting <p>A single urban academic general surgery residency program.</p> Participants <p>Twenty-four residents per period (48 resident-periods, 31 unique residents) and 66 surveyed faculty.</p> Results <p>Total EPA assessments rose from 36 to 100; residents completed approximately 2.6 times as many assessments after the intervention (incidence-rate ratio 2.58, 95% CI 1.17 to 5.73; <i>p</i> = 0.019), an interval spanning a modest to a large effect. Resident participation doubled, from 37.5 to 75% (<i>p</i> = 0.019), and assessments expanded across all phases of care. Activity varied by training level (<i>p</i> = 0.009), peaking among mid-level residents, and did not differ by categorical versus preliminary status. About 40% of the increase reflected resident cohort turnover, and the within-resident change was not statistically significant.</p> Conclusions <p>A structured, ADKAR-guided re-engagement strategy was associated with substantially greater EPA assessment activity. Because gains partly reflected cohort turnover and a concurrent national trend, these uncontrolled results warrant caution, and the study measured EPA utilization only, not feedback quality, learning, or competency. Nonetheless, the reproducible bundle offers a practical template for programs facing low EPA engagement.</p>

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When implementing SIMPL is not so simple: an ADKAR-guided re-implementation and engagement strategy in a general surgery residency

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Jandie Posner,
  • Ramiz Kardan,
  • Moshumi Godbole,
  • Jason Lei,
  • Benjamin Moran,
  • Ramsey M. Dallal

摘要

Objective

Entrustable professional activities (EPAs) are now required for general surgery residency assessment, typically through the SIMPL platform, but adoption has been limited by inconsistent engagement. We evaluated whether a structured re-engagement strategy guided by the ADKAR change-management framework increased EPA assessment activity.

Design

Single-center before-after quality-improvement study reported per SQUIRE 2.0. A faculty survey mapped barriers to ADKAR domains and informed a multicomponent intervention (faculty and resident re-education, a monthly leaderboard, and recognition of high participation) delivered from August to December 2024. EPA activity was compared between matched calendar quarters before (January to March 2024) and after (January to March 2025) the intervention, using count-data regression adjusted for postgraduate year and resident type and accounting for residents present in both periods.

Setting

A single urban academic general surgery residency program.

Participants

Twenty-four residents per period (48 resident-periods, 31 unique residents) and 66 surveyed faculty.

Results

Total EPA assessments rose from 36 to 100; residents completed approximately 2.6 times as many assessments after the intervention (incidence-rate ratio 2.58, 95% CI 1.17 to 5.73; p = 0.019), an interval spanning a modest to a large effect. Resident participation doubled, from 37.5 to 75% (p = 0.019), and assessments expanded across all phases of care. Activity varied by training level (p = 0.009), peaking among mid-level residents, and did not differ by categorical versus preliminary status. About 40% of the increase reflected resident cohort turnover, and the within-resident change was not statistically significant.

Conclusions

A structured, ADKAR-guided re-engagement strategy was associated with substantially greater EPA assessment activity. Because gains partly reflected cohort turnover and a concurrent national trend, these uncontrolled results warrant caution, and the study measured EPA utilization only, not feedback quality, learning, or competency. Nonetheless, the reproducible bundle offers a practical template for programs facing low EPA engagement.