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Objective:
To examine if mid-rotation feedback using a developed standardized Entrustable Professional Activity (EPA) checklist specific to diagnostic breast imaging improves the frequency and quality of resident trainee feedback and attending radiologists’ perceptions regarding their use of this checklist for their trainees.

Materials and Methods:
A diagnostic breast imaging checklist was developed based on content from a peer-reviewed EPAs for breast imaging. It was piloted for response process validity to teaching attendings and residents. Set criteria were established for residents to participate including spending at least 5 days on the diagnostic breast imaging service. Pre- and post-intervention Likert-question surveys were developed to assess gains. Scores were summarized by mean and SD. A research coordinator obtained informed consent. Faculty and residents completed a pre-implementation survey; teaching attendings used the checklist to provide mid-rotation feedback to residents on service; residents completed a post-implementation survey at end of rotation and attendings at end of study period. Study protocol approved by the IRB for all sites.

Results:
The checklist containing content and response process validity evidence was implemented into daily teaching activities during two month period at 3 institutions . Residents (n = 14) and teaching attendings (n = 10) completed the pre-implementation survey; 4 residents thus far have completed the post-implementation survey. Prior to implementation of the feedback checklist, 64% reported being only somewhat or not at all comfortable determining what imaging views are needed for diagnostic breast imaging workup. 64% agreed that a structured checklist to evaluate performance in breast imaging would be helpful. After implementation of the checklist, 100% residents reported the quality of the verbal feedback with use of checklist as above satisfactory and exceptional. 75% found the checklist to be helpful to evaluate their performance and strongly agreed that feedback allowed them to tailor their studying to areas that need improvement. All teaching attendings were fellowship trained in breast imaging radiology. Prior to implementation of the checklist, 91% felt a structured checklist to evaluate trainee performance would be helpful.

Conclusion:
An instrument containing validity evidence was developed and successfully piloted to deliver feedback to residents during a breast imaging rotation. Very early data suggests addition of the EPA checklist may improve attending’s ability to provide specific, actionable, and standardized feedback to trainees regardless of resident experience. Although the study is its early phase of data collection, it appears that residents endorse mid-rotation feedback given with the aid of a developed checklist, which also helped them to tailor self-directed learning to identified areas of needed improvement. Ongoing data collection is needed to study these early-study trends further and examine the overall effectiveness of this developed instrument.