D.A. Turner is vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, and consulting professor, Duke University Medical Center, Durham, North Carolina. At the time this work was completed, he was associate professor, Duke University Medical Center, Durham, North Carolina.
A. Schwartz is the Michael Reese Endowed Professor of Medical Education, interim head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
Acad Med. 2021 Jul 1;96(7S):S22-S28. doi: 10.1097/ACM.0000000000004091.
Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate.
In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level.
The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001).
Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.
可委托的专业活动（EPAs）是基于能力的医学教育（CBME）的一种方法，已经开发了 7 项 EPAs，这些活动涵盖了所有儿科亚专业相关的内容。然而，目前尚不清楚 fellowship 项目主任（FPD）认为毕业需要何种程度的监督。儿科亚专业调查员网络（SPIN）调查了 FPD 对学员成功毕业所需的最低监督水平的看法。
2017 年，SPIN 调查了所有经过认证的 14 个亚专业 fellowship 的 FPD。对于每个 EPA，设定了毕业所需的最低监督级别（从仅观察到无监督实践不等），使得不超过 20%的 FPD 会接受较低的级别。
调查的回复率为 82%（660/802）。毕业所需的最低监督级别在 7 项 EPA 中从 2（直接）到 4（复杂病例的间接）不等，EPA 之间存在显著差异。希望降低最低监督级别要求的 FPD 比例从 3%到 17%不等。与 4 项非临床 EPA（质量改进、管理、专业内领导、奖学金）相比，3 项临床 EPA（咨询、交接、领导团队）的最低监督毕业水平更高（P<.001），FPD 让学员低于其最低水平毕业的可能性更低（P<.001）。
所有儿科亚专业的 FPD 之间达成共识，表明在所有 7 项常见儿科亚专业 EPA 毕业后， fellowship 后所有儿科亚专业的毕业生可能都需要持续监督。随着 CBME 计划的实施，为新毕业生提供支持的流程和基础设施是领导者的重要考虑因素。
