Abstract
An entrustable professional activity (EPA) model was used to assess the anaesthesia and surgery competence of year four students during elective neutering procedures over three academic years (Cohort A, Cohort B and Cohort C). Two competence thresholds were defined by an expert panel, the minimum acceptable standard (MAS) and the standard expected at the start of final year rotations (SFR). The assessment scheme performed as expected, median level of supervision achieved by students either matched or exceeded the SFR for all EPAs except one which matched the MAS. Semester of assessment was associated with student performance, with more students in Semester 2 achieving the SFR. In the EPAs assessing pain management, documentation and patient discharge, Cohort A was associated with reduced student performance, this could be explained by changes in the delivery of teaching in earlier parts of the program enhancing performance in subsequent academic years. For all EPAs combined and individual EPAs (3,5,6,8 and 9) student performance at the SFR was associated with academic year. For all EPAs assessed combined and EPAs 3,8 and 9 there was a reduction in the proportion of students achieving the SFR threshold in each successive year. At the MAS the only association for the combination of all EPAs was with Cohort C. This progressive reduction in performance may have been related to the negative effect of decreasing time spent at the neutering clinic and loss of feedback opportunity outweighing the positive effects of increased staff:student ratio and improvements in the preparative phases.