Minimum Supervision Levels Required by Program Directors for Pediatric Pulmonary Fellow Graduation

Area of Science:

• Medical Education
• Pediatric Subspecialties

Background:

• Entrustable professional activities (EPAs) define core subspecialist tasks for independent practice.
• EPAs are used in some programs, but their summative assessment role for pediatric pulmonology fellowship graduation is unstudied.

Purpose of the Study:

• To ascertain the minimum supervision level pediatric pulmonary program directors (PDs) require for fellow graduation.
• To compare this graduation supervision level with that expected for practicing subspecialists across five key pediatric pulmonology EPAs.

Main Methods:

• A modified Delphi approach was used to create supervision scales for pediatric pulmonology EPAs.
• A national survey of US pediatric pulmonary PDs was conducted via the Subspecialty Pediatric Investigators Network.

Main Results:

• Forty-six PDs responded (85% rate). Most PDs did not require unsupervised practice (level 5) for graduation.
• The median minimum supervision level for graduation was 4 (indirect supervision for complex cases).
• A statistically significant difference exists between supervision levels for graduation versus independent practice for all EPAs.

Conclusions:

• Most PDs graduate fellows who may still need indirect supervision for complex cases.
• Findings suggest a need to re-evaluate training program structures, outcomes, and early career support for pediatric pulmonologists.