EPA ratings reveal self-assessment differences among Chinese cardiology residents

A cross-sectional study at Xiangya Hospital of Central South University found substantial differences between cardiovascular medicine residents’ self-assessments and supervisors’ ratings across postgraduate-year cohorts. In the first postgraduate year, residents scored themselves significantly higher than their supervisors did on all 15 entrustable professional activities assessed. The gap was smaller in the second-year cohort, while third-year residents received significantly higher supervisor scores than self-scores on multiple activities.

The findings show that residents’ and supervisors’ perceptions of competence did not align uniformly, but the study did not follow the same individuals over time and therefore cannot establish that either group changed as training progressed. Researchers enrolled 156 internal medicine resident physicians who were completing cardiovascular medicine rotations at the hospital between January 2024 and November 2025. They grouped participants into three cohorts—PGY1, PGY2 and PGY3—and selected 22 trained supervisor physicians to serve as evaluators.

Each resident and supervisor provided scores through a 15-item entrustable professional activity questionnaire. The questionnaire was designed to capture perceived competence across professional activities, with residents assessing themselves and trained supervisors assessing the same residents. The residents’ self-assessment results were more limited: self-rated performance differed significantly among cohorts only for basic clinical tasks, while ratings for high-complexity competencies did not differ significantly between PGY2 and PGY3 residents.

Radar-chart comparisons showed that PGY1 residents’ self-assessment scores were significantly higher than their supervisor scores for every EPA examined. That discrepancy narrowed in PGY2. Among PGY3 residents, by contrast, supervisor scores were significantly higher than self-assessment scores for multiple EPAs.

These were comparisons between separate cohorts, not measurements of longitudinal change within individual residents. Exploratory analyses also examined whether self-assessment scores differed by gender within each training cohort. PGY1 and PGY2 residents did not show significant self-assessment differences between male and female participants.

In the PGY3 cohort, however, male residents gave significantly higher self-ratings than female residents for specific diagnostic and technical EPAs. The study did not establish the cause of these subgroup differences, and the authors described the gender analyses as exploratory. The findings therefore identify a difference within one senior cohort rather than a general pattern across the entire sample or a demonstrated gender effect in cardiovascular medicine training.

The results support further evaluation of integrated self- and supervisor-rated EPA assessment as a way to distinguish residents at different training stages and inform individualized feedback. These limitations follow directly from the single-center, cross-sectional design: differences among PGY cohorts cannot be interpreted as improvements over time, and the results may not generalize beyond the hospital studied. The investigators concluded that longitudinal, multicenter studies are needed to determine whether the EPA-based tool can reliably track competence, respond to training-related changes and provide meaningful educational value.

Until then, the observed disparities are best understood as differences between resident and supervisor perceptions in a single Chinese hospital cohort, not as evidence of developmental trajectories or training outcomes.

Subject of Research: Self- and supervisor-rated EPA assessments of cardiovascular medicine residents in China

Article Title: Entrustable professional activities for cardiovascular medicine residents in China: a cross-sectional study

Article References: Peng, M., Chen, L., Ye, Q., Hu, Q., Shi, R., Bai, Y., Liu, S., & Zeng, W.-J. (2026). Entrustable professional activities for cardiovascular medicine residents in China: a cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10353-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10353-0

Keywords: cardiology residents, entrustable professional activities, competency assessment, self-assessment, supervisor ratings, medical education, residency training, gender differences, China, Entrustable, professional, activities