Table 2.

Examples of Low, Moderate, and High-Quality QuAL Scores on Narrative Feedback in EPA Observation Forms

EPA Observation Narrative Comment	QuAL Score Criteria With Examples From EPA Observation Narrative Comments
	Evidence (/3)	Suggestion (/1)	Connection (/1)	Total QuAL Score
None. Mandatory comment fields bypassed by entering a period	0: No comment made	0: No suggestion	0: No connection	0
“Procedure performed well”	1: Comment is made, no behavior description or patient context	0: No suggestion	0: No connection	1
“Doing a thorough job; Keep working on breastfeeding advice”	1: Comment made, no behavior description or patient context	1: Suggestion made	0: Connection unclear	2
“Complex bronch, took careful time and attention to recognize unique anatomy, and also to balance risk/benefit of pursuing further intervention (suction or leave clot alone)”	3: Detailed description of resident behavior and patient context	0: No suggestion	0: No connection	3
“Well thought through with a contingency/back up plan. Recognizes the nuances, and not just the ‘numbers’ for successful extubation. Suggest additional teaching around the case to help the residents understand some of the nuances and pitfalls to extubation.”	2: Detailed description of resident behavior, but no context provided	1: Suggestion included	1: Suggestion is connected to evidence	4
“Identifying most concerning diagnosis and treated appropriately in context of patient risk factors (use of plavix due to high bleeding risk). Considered other ddx, and created plan (discuss with heme onc re chemo, considering v/q scan). Discussed care with family regarding decision for angio; make plan for what to do with other rate slowing agents if placing on new medication.”	3: Detailed description of resident behavior and patient context	1: Suggestion included	1: Suggestion is connected to evidence	5

Abbreviations: QuAL, Quality of Assessment of Learning; EPA, entrustable professional activity.