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Entrustable Professional Activity Framework Implementation and Impressions from U.S. and Canadian Pediatric
Michael E Kim1, Ashley Neal2, Ruchika Karnik3
1Division of Cardiac Critical Care, Department of Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. michael.kim@seattlechildrens.org.
Pediatric Cardiology
|May 7, 2026
Summary
Nearly half of pediatric cardiology fellowship programs use Entrustable Professional Activities (EPAs) for trainee assessment. While EPAs offer objective evaluations, faculty time and consistent assessment remain challenges.
Area of Science:
- Medical Education
- Pediatric Cardiology Fellowship Training
- Competency-Based Assessment
Background:
- Medical training frameworks are evolving to assess clinical competency.
- Entrustable Professional Activities (EPAs) guide education and assessment in practice.
- U.S. Pediatric cardiology fellowship programs have been implementing EPAs since 2015.
Purpose of the Study:
- To investigate the current landscape of EPA implementation in U.S. pediatric cardiology fellowship programs.
- To understand fellowship training program directors' perceptions of EPA use.
Main Methods:
- A mixed-methods study using grounded theory.
- A survey instrument distributed to the Society of Pediatric Cardiology Training Program Directors (August-October 2023).
- Qualitative analysis of open-ended prompts and quantitative summary statistics.
Main Results:
- 39% of program directors responded; >80% use competency-based frameworks.
- Approximately 40% utilize EPA-based assessments, reporting high satisfaction with longitudinal performance tracking.
- Key themes: EPAs provide objective assessments, require significant faculty effort, and face limitations in evaluator consistency.
Conclusions:
- Nearly half of responding pediatric cardiology fellowship programs are implementing EPAs.
- Perceived strengths of EPAs exist alongside early reservations.
- Continued follow-up is recommended for programs and trainees assessed under the EPA model.
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