Pediatric Fellows and Their Ability to Meet Minimum Supervision Levels at Graduation.

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Objective: Assessing pediatric subspecialty fellows using entrustable professional activities (EPAs) to determine readiness for graduation has not been described. We aimed to determine whether graduating pediatric fellows are meeting the minimum supervision level at graduation previously identified by program directors for the clinical EPAs and the relationship between meeting these levels and initial subspecialty board certification.

Methods: Pediatric fellows in 14 subspecialties were assessed by clinical competency committees in the spring before graduation in 2019 to 2022 on 3 EPAs common to all subspecialties that involve direct patient care and the subspecialty-specific EPAs. Publicly available board certification data were obtained from the American Board of Pediatrics.

Results: EPA supervision levels were collected on 1480 fellows, representing approximately 27% of all graduating fellows. A total of 117 (7.9%) fellows did not meet the minimum supervision level for at least 1 EPA, with some requiring direct supervision. Of fellows who did not achieve the expected level at graduation, 83 (70.9%) were certified. Those who met the minimum level for all clinical EPAs had a higher certification rate compared with those who did not meet the minimum for at least 1 EPA (80.6% vs 70.9%; P = .01).

Conclusions: Almost 10% of pediatric fellows are not meeting the expected supervision level for the clinical EPAs at graduation, and yet over 70% of them passed their subspecialty certification examination. This study provides support for using EPAs to determine readiness for graduation and demonstrates that some fellows may need additional training or continued supervision after completion of their fellowship.