Abstract
Entrustable professional activities (EPAs) are “observable essential tasks expected to be performed by a physician for safe patient care in practice.” Six Pediatric Cardiology (PC) EPAs and their level of supervision (LOS) scales were developed by medical educators in PC using a modified Delphi process and reviewed by the Subspecialty Pediatrics Investigator Network (SPIN). However, their general use in assessment for PC fellows for graduation requirements has yet to be studied. The objective of this study was to determine the minimum LOS required for PC fellows to graduate and compare it with the minimum LOS expected for safe and effective practice for the six PC EPAs, from the perspective of the PC Fellowship Program Directors(FPD). All Fellowship Program Directors(FPD) of ACGME-accredited PC fellowships were surveyed through SPIN between April 2017 and August 2017. For each of the PC EPAs, the FPDs were asked to indicate the minimum LOS expected for graduation and whether they would allow a fellow to graduate if this level was not achieved and the minimum LOS expected for a practicing pediatric cardiologist to provide safe and effective patient care. The minimum LOS was defined as the LOS for which no more than 20% of FPDs would want a lower level. The survey response rate was 80% (47/59). The majority of the FPDs did not require a minimum LOS of five corresponding to unsupervised practice in any of the six PC EPAs at graduation. For EPAs related to imaging, arrhythmia management, and management of cardiac problems, the minimum LOS for graduation was 3, corresponding to being “trusted to perform a task with indirect supervision for most simple and a few complex cases.” For the EPAs related to interventional cardiology, heart failure pulmonary hypertension, and cardiac intensive care, the minimum LOS for graduation was 2, corresponding to being “trusted to perform a task only with direct supervision and coaching.” The minimum LOS considered necessary for safe and effective practice for all but one EPA was 3. For the EPA related to the management of cardiac problems, the minimum LOS for safe practice was 4, corresponding to being “trusted to execute tasks independently except for few complex and critical cases.” Most PC FPDs reported they would not require fellows to achieve the highest entrustment level for any of the six PC EPAs for graduation. It is crucial that educational programs evolve to address these essential activities during training better and that stakeholders ensure that graduating PC fellows have adequate resources and infrastructure to continue professional development as early career pediatric cardiologists.
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References
Carraccio C et al (2017) Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Acad Med 92(3):324–330
Hicks PJ et al (2010) The pediatrics milestones: conceptual framework, guiding principles, and approach to development. J Grad Med Educ 2(3):410–418
Tocco D, Jain AV, Baines H (2014) The pediatrics milestone pilot project: perspectives of current pediatric residents. Acad Pediatr 14(2 Suppl):S8-9
ten Cate O (2005) Entrustability of professional activities and competency-based training. Med Educ 39(12):1176–1177
Mink RB et al (2018) Validity of level of supervision scales for assessing pediatric fellows on the common pediatric subspecialty entrustable professional activities. Acad Med 93(2):283–291
Mink RB et al (2018) Competencies, milestones, and a level of supervision scale for entrustable professional activities for scholarship. Acad Med 93(11):1668–1672
Mink R et al (2018) Creating the subspecialty pediatrics investigator network. J Pediatr 192:3-4e2
Mulder H et al (2010) Building a competency-based workplace curriculum around entrustable professional activities: the case of physician assistant training. Med Teach 32(10):e453–e459
Boyce P et al (2011) Using entrustable professional activities to guide curriculum development in psychiatry training. BMC Med Educ 11:96
Moore D, Young CJ, Hong J (2017) Implementing entrustable professional activities: the yellow brick road towards competency-based training? ANZ J Surg 87(12):1001–1005
Weiss P et al (2021) Minimum supervision levels required by program directors for pediatric pulmonary fellow graduation. ATS Scholar 2(3):360–369
Hsu DC et al (2022) Pediatric emergency medicine fellowship program directors’ viewpoint: minimum levels of entrustment for graduating fellows and practicing physicians to perform the subspecialty’s professional activities. Pediatr Emerg Care 39:574–579
Baffa JM et al (2018) Using entrustable professional activities to assess graduation readiness in pediatric cardiology. J Am Coll Cardiol 71(11):2624–2624
Turner DA et al (2021) Continued supervision for the common pediatric subspecialty entrustable professional activities may be needed following fellowship graduation. Acad Med 96(7S):S22–S28
Schumacher DJ et al (2020) Longitudinal assessment of resident performance using entrustable professional activities. JAMA Netw Open 3(1):e1919316
ten Cate O et al (2015) Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No 99. Med Teach 37(11):983–1002
Carraccio C et al (2016) Advancing competency-based medical education: a charter for clinician–educators. Acad Med 91(5):645–649
Acknowledgements
We would like to acknowledge Dr. Gina Baffa who was involved with the inception of the original survey and study.
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The study was supported by the American Board of Pediatrics Foundation.
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All authors have agreed with the content and approved the final version and gave consent for submission. RK: interpreted the data, drafted the main manuscript, and revised it critically for important intellectual concept, as well as prepared the tables. SS, RM, and BR: made substantial contributions to the conception of the study, drafting the original survey and collecting data. AS: performed statistical analysis, interpretation of the data and prepared the graphs. JG, LHF, AEN, CJM, MEK, and DAT: revised the draft critically for important intellectual content.
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Dr. Alan Schwartz serves as Director of APPD Longitudinal Educational Assessment Research Network through a contract from APPD to his institution.
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Karnik, R., Robinson, B., Glickstein, J. et al. Minimum Supervision Levels Required for Pediatric Cardiology Fellowship Graduation by Pediatric Cardiology Fellowship Program Directors. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03371-y
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DOI: https://doi.org/10.1007/s00246-023-03371-y