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Graduating Residents' Readiness for Unsupervised Practice.

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Most graduating residents are not ready for unsupervised practice in general pediatrics entrustable professional activities (EPAs). This study reveals a significant gap in readiness, highlighting areas for improvement in residency training.

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Area of Science:

  • Medical Education
  • Pediatric Residency Training
  • Competency-Based Medical Education

Background:

  • Assessing resident readiness for unsupervised practice is crucial for patient safety and effective healthcare delivery.
  • Entrustable Professional Activities (EPAs) provide a framework for defining and assessing core competencies in medical training.

Purpose of the Study:

  • To evaluate the proportion of graduating pediatric residents deemed ready for unsupervised practice across 17 general pediatrics EPAs.
  • To identify any disparities in readiness between pediatric and medicine/pediatrics residents.
  • To track trends in readiness over three academic years.

Main Methods:

  • Retrospective analysis of entrustment-supervision levels assigned by clinical competency committees for graduating residents.
  • Data collected for the 2021-22, 2022-23, and 2023-24 academic years.
  • Mixed-effects logistic regression used to compare readiness rates across academic years.

Main Results:

  • No EPA demonstrated readiness for unsupervised practice in over 89% of graduating residents.
  • Only 31.3% of residents were ready for all EPAs.
  • Graduating medicine/pediatrics residents showed higher readiness for all EPAs compared to pediatrics residents (P=.002).
  • Readiness rates for all EPAs increased from 18.0% to 38.5% across the study years (P<.001).

Conclusions:

  • A notable gap exists in the readiness of graduating residents for unsupervised practice in general pediatrics.
  • Factors beyond resident performance may influence entrustment decisions.
  • Further investigation and potential curriculum adjustments are warranted to ensure graduates are fully prepared.