Establishing a Competency Based Medical Education Curriculum for International Medical Graduates Pursuing Pediatric Surgery Training in High-income Countries.

Objective: Canada's Royal College of Physicians and Surgeons established a competency-based medical education (CBME) training in pediatric surgery in 2021. Specialty-specific Entrustable Professional Activities (EPAs), foundational to CBME, were created within this framework as tools to assess fellow progression. We aimed to determine which of these EPAs were appropriate for assessment of international medical graduates (IMGs) from Low and Lower-Middle-Income Countries (LMICs) training in pediatric surgery in Canada.

Methods: Subject matter experts (SMEs) were defined as surgeons with experience in global pediatric surgical education. SMEs were invited to complete a survey tool to assess the relevance of the EPAs for IMG fellows. Each item was rated on a 5-point Likert scale, and narrative comments were collected along with demographic data from respondents. An EPA was determined to be relevant if more than 80 % of SMEs rated it at 4 or higher.

Results: Six SMEs completed the survey. The average duration of experience training pediatric surgery fellows was 13 years, and all SMEs had previously used EPAs for fellow assessment. The average duration of experience supporting LMIC environments was 16 years. Relevance criteria were met for 20 of the 38 EPAs. EPAs not meeting relevance criteria included redundant EPAs, activities not applicable to the LMIC environment, and non-technical skills.

Conclusions: EPAs remain a valuable tool for fellow assessment. However, not all the EPAs seem relevant for IMGs training in Canada. Context-relevant education and training programs for LMIC trainees in pediatric surgery are critical to fortifying the global surgical workforce.