Exploring How the New Entrustable Professional Activity Assessment Tools Affect the Quality of Feedback Given to Medical Oncology Residents

  • Anna Tomiak
  • Heather Braund
  • Rylan Egan
  • Nancy Dalgarno
  • Jeffrey Emack
  • Mary-Anne Reid
  • Nazik HammadEmail author


The post-graduate medical programs at Queen’s University transitioned to a competency-based medical education framework on July 1, 2017. In advance of this transition, the Medical Oncology program participated in a pilot of six Entrustable Professional Activities (EPAs) focused workplace-based assessment (WBA) tools with faculty and residents. The purpose of this sequential explanatory mixed method study was to determine the extent to which these WBAs provided quality feedback for residents. The WBAs were introduced into daily clinical practice and, once completed, were collected by the research team. A resident focus group (n = 4) and faculty interviews (n = 5) were also conducted. Focus group and interview data were analyzed using an emergent thematic analysis. Data from the completed assessment tools were analyzed using both descriptive statistics and a literature-informed framework developed to assess the quality of feedback. Six main findings emerged: Verbal feedback is preferred over written; providing both written and verbal feedback is important; effective feedback was seen as timely, specific, and actionable; the process was conceptualized as coaching rather than high stakes; there were logistical concerns about the WBAs, and additional clarification about the WBA tools is needed. This study provides insight into faculty and resident perceptions of quality feedback and the potential for WBA tools to assist in providing effective feedback to residents as we shift to competency-based medical education in Canada. Our results suggest the need for additional faculty development around the use of the tools, and their intended role, and the elements of quality feedback.


Competency-based medical education Faculty perspectives Feedback Medical oncology Resident perspectives Workplace-based assessments 



The authors would like to thank the Queen’s University Maudsley Scholarship and Research Fund for their financial support, to all the faculty and residents who volunteered their time to participate in this research, and to Terry Soleas (a research assistant with the Office of Professional Development and Educational Scholarship) who helped collect the data.

Compliance with Ethical Standards

This study received the appropriate ethical clearance from the Health Sciences Research Ethics Board (File no. 6019583).

Supplementary material

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ESM 1 (PDF 85 kb)


  1. 1.
  2. 2.
    Carraccio CL, Englander R (2013) From Flexner to competencies: reflections on a decade and the journey ahead. Acad Med 88(8):1067–1073CrossRefGoogle Scholar
  3. 3.
    Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 376(9756):1923–1958CrossRefGoogle Scholar
  4. 4.
    Dittrich C, Kosty M, Jezdic S, Pyle D, Berardi R, Bergh J, el Saghir N, Lotz JP, Österlund P, Pavlidis N, Purkalne G, ESMO/ASCO Global Curriculum Working Group (2016) ESMO/ASCO recommendations for a global curriculum (GC) in medical oncology-edition 2016. Ann Oncol 27(8):1378–1381CrossRefGoogle Scholar
  5. 5.
    Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C (2002) Shifting paradigms: from Flexner to competencies. Acad Med 77(5):361–367CrossRefGoogle Scholar
  6. 6.
    Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, Harris P, Glasgow NJ, Campbell C, Dath D, Harden RM, Iobst W, Long DM, Mungroo R, Richardson DL, Sherbino J, Silver I, Taber S, Talbot M, Harris KA (2010) Competency-based medical education: theory to practice. Med Teach 32(8):638–645CrossRefGoogle Scholar
  7. 7.
    van der Vleuten CP, Schuwirth LW (Mar 2005) Assessing professional competence: from methods to programmes. Med Educ 39(3):309–317CrossRefGoogle Scholar
  8. 8.
    Norcini J, Anderson B, Bollela V, Burch V, Costa MJ, Duvivier R, Galbraith R, Hays R, Kent A, Perrott V, Roberts T (2011) Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 conference. Med Teach 33(3):206–214CrossRefGoogle Scholar
  9. 9.
    Maudsley G, Strivens J (2000) Promoting professional knowledge, experiential learning and critical thinking for medical students. Med Educ 34:535–544CrossRefGoogle Scholar
  10. 10.
    Griffiths J, Dalgarno N, Schultz K, Han H (2016) How are we changing the culture of assessment?. World Summit on CBME. Barcelona, SpainGoogle Scholar
  11. 11.
    Steinert Y, Mann K, Centeno A, Dolmans D, Spencer J, Gelula M, Prideaux D (2006) A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME guide no. 8. Med Teach 28(6):497–526CrossRefGoogle Scholar
  12. 12.
    Boehler ML, Rogers DA, Schwind CJ, Mayforth R, Quin J, Williams RG, Dunnington G (2006) An investigation of medical student reactions to feedback: a randomised controlled trial. Med Educ 40(8):746–749CrossRefGoogle Scholar
  13. 13.
    McConnell MM, Harms S, Saperson K (Apr 2016) Meaningful feedback in medical education: challenging the "failure to fail" using narrative methodology. Acad Psychiatry 40(2):377–379CrossRefGoogle Scholar
  14. 14.
    Feeney EJ (2007) Quality feedback: the essential ingredient for teacher success. The Clearing House 80(4):191–198CrossRefGoogle Scholar
  15. 15.
    Tekian A, Watling CJ, Roberts TE, Steinert Y, Norcini J (2017) Qualitative and quantitative feedback in the context of competency-based education. Med Teach 39(12):1245–1249CrossRefGoogle Scholar
  16. 16.
    Massie J, Ali JM (2016) Workplace-based assessment: a review of user perceptions and strategies to address the identified shortcomings. Adv Health Sci Educ Theory Pract 21(2):455–473CrossRefGoogle Scholar
  17. 17.
    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101CrossRefGoogle Scholar
  18. 18.
    Watling C, Driessen E, van der Vleuten CP, Lingard L (2014) Learning culture and feedback: an international study of medical athletes and musicians. Med Educ 48(7):713–723CrossRefGoogle Scholar
  19. 19.
    Sargeant J, Lockyer J, Mann K, Holmboe E, Silver I, Armson H, Driessen E, MacLeod T, Yen W, Ross K, Power M (2015) Facilitated reflective performance feedback: developing an evidence- and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Acad Med 90(12):1698–1706CrossRefGoogle Scholar
  20. 20.
    Dweck CS (2006) Mindset: The new psychology of success. New York. In: NY: penguin Random House LLCGoogle Scholar
  21. 21.
    Frank JR, Snell L, Sherbino J et al. (2014) Draft CanMEDS 2015 Milestones Guide. Ott R Coll Physicians Surg CanGoogle Scholar
  22. 22.
    Yeager DS, Dweck CS (2012) Mindsets that promote resilience: when students believe that personal characteristics can be developed. Educ Psychol 47:302–314CrossRefGoogle Scholar
  23. 23.
    Dudek N, Karpinski J, & Richardson D (2017) Words are powerful: coaching and clinical teaching. . International Conference on Residency Education. Quebec City, QuebecGoogle Scholar

Copyright information

© American Association for Cancer Education 2019

Authors and Affiliations

  1. 1.Department of Oncology, Cancer Centre of Southeastern Ontario, Burr 2, Kingston General HospitalQueen’s UniversityKingstonCanada
  2. 2.Faculty of Education, Office of Professional Development and Educational Scholarship, Botterell HallQueen’s UniversityKingstonCanada
  3. 3.Health Quality ProgramsQueen’s UniversityKingstonCanada
  4. 4.Office of Professional Development and Education Scholarship, Botterell HallQueen’s UniversityKingstonCanada
  5. 5.Department of Oncology, Cancer Centre of Southeastern OntarioBurr 2, Kingston General HospitalKingstonCanada
  6. 6.Department of Kinesiology - College of EducationMichigan State UniversityEast LansingUSA
  7. 7.Medical Oncology Residency Training Program, Department of Oncology, Cancer Centre of Southeastern Ontario, Burr 2, Kingston General HospitalQueen’s UniversityKingstonCanada

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