The development status of entrustable professional activities-based curricula in orthopedic and neurosurgical spinal surgery: a systematic review.

Background: Postgraduate medical training often lacks clearly defined, assessable outcomes. Entrustable professional activities (EPAs) have emerged as a promising framework for competency-based training, aiming to improve transparency, accountability, and efficiency in specialist education. This systematic review investigates the current development status of EPA-based curricula in orthopedic and neurosurgical spinal surgery and highlights their potential to address educational challenges in this high-stakes field. Methods: A systematic review was conducted combining database studies (PubMed and Embase) and gray literature screening through professional societies' websites and direct inquiries. Two reviewers independently screened, extracted, and synthesized the data. Given the anticipated heterogeneity among the included studies, a narrative synthesis was performed, while a quantitative synthesis was not feasible. No formal risk-of-bias assessment was conducted; however, potential sources of bias related to language, scope, and publication period were acknowledged and discussed. Results: Out of 15,768 initial records, only 4 relevant papers were identified. The EPAs in these studies were developed primarily through expert consensus methods such as modified Delphi or nominal group techniques. Additionally, among the 10 professional societies analyzed, only the AO Foundation (AO Spine) and the Royal College of Physicians and Surgeons of Canada provided explicit EPA frameworks for spinal surgery, contributing together to 26 EPAs. The limited number and heterogeneity of sources underscore the exploratory nature of this review and the current lack of standardized, spine-specific EPA curricula. Conclusion: EPA-based curricula in spinal surgery remain largely undeveloped. While conceptual frameworks exist, their implementation into structured residency programs is still in its infancy. This review provides a foundational overview of the existing EPAs and methodological approaches, offering a reference point for future curriculum development. Collaborative initiatives among professional societies are strongly encouraged to define, validate, and implement specialty-specific EPAs for spinal surgery, fostering competency-based education and improving training outcomes.