Defining Core Entrustable Professional Activities For Plastic Surgery: Results Of A National Delphi Process

PURPOSE: Entrustable Professional Activities (EPAs) provide a framework for competency-based medical education by defining discrete units of professional tasks that trainees can be entrusted to perform independently once competence is demonstrated. While EPAs have been adopted in general surgery, plastic and reconstructive surgery (PRS) presents unique challenges due to its breadth. The American Council of Educators in Plastic Surgery (ACEPS) EPA Task Force previously proposed a preliminary set of PRS-specific EPAs. Building on this foundation, we report results of Round 1 of a national Delphi consensus process to refine and validate EPAs for residency training. METHODS: Fifteen EPAs were evaluated in Round 1. An electronic survey was distributed to all current and former program directors (PDs) and associate PDs of ACGME-accredited PRS residencies. Respondents rated each EPA on: (1) whether it represents a core professional task that every newly graduated plastic surgeon (without subspecialty training) will be qualified to perform unsupervised, (2) and clarity of the description (both on 5-point Likert scales), and (3) frequency of resident exposure (4-point scale: daily to weekly to yearly or less). Consensus was predefined as ≥80% agreement on the first item. Free-text responses for improvements and explanations for disagreement and suggestions for additional EPAs were collected. RESULTS: Forty-four participants completed the survey (52% male, mean 12.4 years in practice). Subspecialty representation was broad, with most commonly general reconstruction (57%), microsurgery (50%), and breast surgery (41%). Consensus was achieved for 13 of 15 EPAs. Highest agreement was observed for The Surgeon as a Manager and Consultant (98%), Non-oncologic Breast Reconstruction (95%), and Aesthetic Surgery of the Body (93%). Two EPAs did not meet the consensus threshold: Congenital Craniofacial Reconstruction (68%) and Composite Craniofacial Reconstruction (70%) (Figure 1). CONCLUSION: Round 1 established consensus for most PRS EPAs and identified areas requiring further refinement, with scope cited as the most frequent concern. Free-text responses have guided revisions for the round 2. The Delphi process will be followed by Q-sorting of milestone to map sub-competencies to the EPAs and define entrustment levels. This effort represents an important step towards validated competency-based training framework for PRS residency programs. We would like to acknowledge the ACEPS EPA task force for their ongoing contributions to this project.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/OS35.cgi*