Pediatric Fellows and Their Ability to Meet Minimum Supervision Levels at Graduation

Area of Science:

• Medical Education
• Pediatric Subspecialties
• Competency-Based Assessment

Background:

• Assessing pediatric subspecialty fellows' readiness for graduation using entrustable professional activities (EPAs) is an underexplored area.
• Program directors previously defined minimum supervision levels for EPAs at graduation.

Purpose of the Study:

• To evaluate if graduating pediatric fellows meet minimum supervision levels for clinical EPAs.
• To examine the relationship between meeting EPA supervision levels and initial subspecialty board certification.

Main Methods:

• 1480 pediatric fellows across 14 subspecialties were assessed on 3 common and subspecialty-specific EPAs from 2019-2022.
• Clinical competency committees evaluated fellows' EPA supervision levels before graduation.
• Board certification data were obtained from the American Board of Pediatrics.

Main Results:

• 7.9% of fellows (117/1480) did not meet the minimum supervision level for at least one EPA.
• Fellows meeting all EPA supervision levels had a higher certification rate (80.6%) than those who did not (70.9%; P=.01).
• 70.9% of fellows not meeting minimum EPA levels were still certified.

Conclusions:

• Approximately 10% of pediatric fellows do not achieve expected EPA supervision levels at graduation.
• The findings support using EPAs for assessing graduation readiness, potentially identifying fellows needing further training.
• A significant proportion of fellows not meeting EPA standards still achieve board certification.