Use of entrustable professional activities for reliable overall entrustment decisions

Area of Science:

• Medical Education
• Pediatrics
• Competency-Based Education

Background:

• Entrustable Professional Activities (EPAs) define essential skills for medical specialists.
• General pediatrics has 17 defined EPAs, but the optimal number for reliable assessment is unknown.
• Accurate assessment of resident readiness is vital for patient safety and effective training.

Purpose of the Study:

• To determine the minimum number of general pediatrics EPAs required for high-reliability entrustment decisions.
• To inform the development of robust assessment strategies for graduating pediatric residents.
• To ensure residents are prepared for unsupervised practice upon completion of training.

Main Methods:

• Collected entrustment-supervision levels for 17 general pediatrics EPAs from 4,250 residents across 48 U.S. programs over three academic years.
• Utilized generalizability and decision studies to analyze biannual midyear and end-of-year competency committee data.
• Examined data based on postgraduate year and data collection timepoints.

Main Results:

• Assessing 6 EPAs yielded a generalizability coefficient of 0.8; 12 EPAs yielded 0.9.
• At graduation, 9 to 13 EPAs are necessary to achieve a generalizability coefficient of 0.9 for entrustment decisions.
• Reliability varied by data collection timepoint (midyear vs. end-of-year) and postgraduate year.

Conclusions:

• 9 general pediatrics EPAs are sufficient for reliable assessment of resident readiness for unsupervised practice.
• A larger number of EPAs may be beneficial for curriculum development, ensuring comprehensive training.
• Findings provide critical data for optimizing pediatric residency assessment and curriculum design.