Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed...

Area of Science:

• Medical Education
• Pediatrics
• Competency-Based Medical Education (CBME)

Background:

• Entrustable professional activities (EPAs) are key to competency-based medical education (CBME).
• Seven EPAs cover essential content for all pediatric subspecialties.
• Fellowship program director (FPD) views on required supervision for graduation remain unexplored.

Purpose of the Study:

• To investigate FPD perceptions of minimum supervision levels for graduating trainees.
• To assess FPD consensus on supervision for 7 common pediatric subspecialty EPAs.

Main Methods:

• A 2017 survey of FPDs across 14 pediatric subspecialties was conducted by the Subspecialty Pediatrics Investigator Network (SPIN).
• For each EPA, the minimum supervision level for graduation was defined as the level at which no more than 20% of FPDs would accept less.
• Survey response rate was 82% (660/802).

Main Results:

• Minimum supervision levels varied from direct (level 2) to indirect for complex cases (level 4) across the 7 EPAs.
• Significant differences in supervision levels were observed between EPAs (P < .001).
• Clinical EPAs required higher supervision levels than nonclinical EPAs, with less FPD willingness to graduate trainees below the minimum.

Conclusions:

• FPD consensus highlights the need for ongoing supervision for graduates in all 7 pediatric subspecialty EPAs.
• Implementing CBME requires robust processes and infrastructure to support new graduates.
• This study provides critical data for refining CBME in pediatric subspecialties.