Exploring the effects of timing on resident experiences with entrustable professional activity-based feedback and assessment

PURPOSE: Timing is crucial to effective feedback delivery. Optimizing feedback timing can enhance learner satisfaction, -promote engagement, and improve feedback uptake. Despite widespread adoption of entrustable professional activity (EPA) assessment forms, little research has examined the impact of timing on residents' perceptions of these formative workplace-based assessments. The current study sought to examine the effect of timing on residents' perceptions of EPA-based feedback. METHOD: The authors conducted 15 semi-structured interviews with Internal Medicine residents from the University of Toronto between July and December 2023. Using constructivist grounded theory, data collection occurred alongside -comparative analysis to identify core themes. RESULTS: Residents valued EPAs that were specific, actionable, and opportune. Timing significantly influenced residents' -perception of, and engagement with, EPA-based feedback. Early EPAs forms completed days following an educational -encounter were perceived to possess higher quality feedback, accompany greater opportunities for feedback uptake, and foster a stronger student-teacher relationship. Residents importantly distinguished between early and immediate EPA form completion, noting that the latter may be impractical and fraught with challenging emotions. While late feedback was least preferred, residents acknowledged their tendency to batch and request EPA forms belatedly. Underlying this practice were barriers to feedback-seeking, which residents perceived to be onerous and difficult. Reported concerns included worries over burdening staff and a fear of hidden image and relationship costs. Finally, verbal feedback was highly valued, cultivating a sense of timeliness that was otherwise lost in its absence. CONCLUSIONS: Optimizing the timing of EPA forms as a means of workplace-based assessment, necessitates a balanced -approach with considerations for a learner's readiness for feedback and pragmatism in the face of competing workplace -responsibilities. As EPA forms continue to gain traction as important tools for assessment and feedback, addressing these complexities may alleviate ongoing reports of resident dissatisfaction and facilitate feedback provision within medical education.