Entrustable Professional Activities to Milestones Advisor for Pediatric Subspecialties: Developing a Comprehensive...

This project sought to define the relationship between the Accreditation Council of Graduate Medical Education (ACGME) Milestones 2.0 and Entrustable Professional Activities (EPAs) for each of 15 pediatric subspecialties and create a novel tool that could automate the generation of expected milestone behaviors for a given EPA level of supervision.

Workgroups for each of the pediatric subspecialties selected Milestone 2.0 subcompetencies that were essential to performing each EPA through a modified Delphi approach. Additionally, the groups assigned predicted Milestone levels expected for each EPA Level of Supervision.

Forty percent (6/15) of subspecialties mapped all Milestone subcompetencies to their EPAs. Although variations existed among subspecialties, trainees were generally not expected to have achieved ''expertise'' or (Milestone Level 5) to be ready for practice without supervision (EPA Level of Supervision 5). Group assignments of anticipated Milestones levels for each EPA Level of Supervision were used to create an online tool intended to suggest milestone levels for a subspecialty fellow based on EPA Level of Supervision ratings.

Strengthening pediatric subspecialty educators' understanding of the roles of Milestones 2.0 and EPAs in fellow education is critical to achieve goals of competency-based medical education. This work, which includes a novel tool that predicts milestone levels based on EPA Level of Supervision ratings, represents an important step in delineating the relationship between Milestones 2.0 and EPAs.