Clinical competency committee perceptions of entrustable professional activities and their value in assessing fellows: A qualitative study of pediatric subspecialty program directors

Abstract

Objectives

To examine the composition and processes of Clinical Competency Committees (CCCs) assigning entrustable professional activity (EPA) levels of supervision for pediatric subspecialty fellows and to examine fellowship program director (FPD) perspectives about using EPAs to determine fellows’ graduation readiness.

Methods

A qualitative study was performed using one-on-one interviews with a purposeful sample of pediatric subspecialty FPDs to yield a thematic analysis. Semi-structured interview guides were used for participants who self-identified as EPA users or non-users. Inductive analysis and coding were performed on transcripts until theoretical sufficiency was attained.

Results

Twenty-eight FPDs were interviewed. There was significant variability in the composition and processes of CCCs across subspecialties. FPDs felt that CCCs intuitively understand what entrustment means, allowing for ease of application of level of supervision (LOS) scales and consensus. FPDs perceived that EPAs provided a global assessment of fellows and are one tool to determine graduation readiness.

Conclusions

Although there was variability in the makeup and processes of CCCs across subspecialties, FPDs believe EPAs are intuitive and relatively easy to implement. Consensus can be reached easily using EPA-specific LOS scales focusing on entrustment. FPDs desire a better understanding of how EPAs should be used for graduation.

Keywords:

• Assessment
• medicine – profession
• postgraduate – phase of education

Acknowledgements

We would like to thank Marzia Hazara, B.S., for her contributions study and the ABP Foundation for their financial support.

Disclosure statement

David Turner is employed by the American Board of Pediatrics; the remaining authors have nothing to disclose.

Glossary

Accreditation Council for Graduate Medical Education: The ACGME is a private, 501(c)(3), not-for-profit organization that sets standards for US graduate medical education (residency and fellowship) programs and the institutions that sponsor them, and renders accreditation decisions based on compliance with these standards.

Milestone: Milestones describe performance levels residents and fellows are expected to demonstrate for skills, knowledge, and behaviors in the six Core Competency domains. They lay out a framework of observable behaviors and other attributes associated with a resident’s or fellow’s development as a physician.

Entrustable professional activity: Entrustable Professional Activities (EPAs) offer a practical approach to assessing competence in real-world settings and impact both learners and patients.

Data availability statement

There is no dataset associated with this manuscript.

Additional information

Funding

This work is supported by the American Board of Pediatrics Foundation.

Notes on contributors

Melissa L. Langhan

Melissa L. Langhan, MD, MHS, is an Associate Professor of Pediatrics and Emergency Medicine at the Yale University School of Medicine and is Director of the Pediatric Emergency Medicine fellowship program. She received her BS from the University of Richmond and her medical degree from SUNY Downstate (Brooklyn, NY). She completed her residency and chief residency in pediatrics at the Mount Sinai Medical Center, and her fellowship in Pediatric Emergency Medicine at Yale University. In 2013, Dr. Langhan received her Master’s in Health Science from Yale University. Her research interests include diversity and inclusion in medical education with a focus on applicant assessment methods. She is an active member of the American Academy of Pediatrics, where she serves on the executive committee for the Section of Emergency Medicine and the Pediatric Emergency Medicine Fellowship Directors Committee; she also chairs the Collaborative Scholarship Group. She is currently the Deputy Editor for the American Academy of Pediatrics PREP Emergency Medicine and Chair of the Mentorship/Sponsorship group for the Women in Pediatric Emergency Medicine subcommittee. Her other interests include reading, travel and outdoor activities.

Diane E. J. Stafford

Diane E. J. Stafford, MD, is a Clinical Professor of Pediatrics at Stanford University School of Medicine. She specializes in Pediatric Endocrinology with special interest in disorders of puberty and Prader-Willi syndrome (PWS). Her research interests include medical education curriculum development, faculty development and endocrine dysfunction in PWS. She previously served as chair of the Program Directors Committee and Training Council for the Pediatric Endocrine Society, leading the writing group for the specialty specific EPAs for the American Board of Pediatrics. She currently serves as Associate Division Chief and Associate Fellowship Program Director in Pediatric Endocrinology at Stanford.

Angela L. Myers

Angela L. Myers, MD, MPH, completed her medical degree in 2001 at the University of Missouri-Kansas City School of Medicine and was recognized with the Laura L. Backus, M.D., Memorial Award for Excellence in Pediatrics. Following pediatric residency and fellowship in Pediatric Infectious Diseases (PID) at Children’s Mercy Kansas City, she completed a master’s degree in Public Health with distinction from the University of Kansas. She is currently a Professor of Pediatrics at UMKC School of Medicine and the Division Director of PID at Children’s Mercy, Kansas City. Prior to this role, Dr. Myers served as the PID Fellowship Program Director for 8 years. She was elected to the Association of Pediatric Program Directors (APPD) Fellowship Program Directors Executive Committee, serving as Chair from 2016 to 2017. Dr. Myers served as the Chair for the PID Society Training Program Committee, and serves on the American Board of Pediatrics, PID Subboard. Dr. Myers was awarded the Clinical Advances in Pediatrics Faculty Award in 2015 for outstanding teaching and support of the community pediatrician, the Department of Pediatrics Established Career for Clinical Care Achievement Award in 2018, the Department of Pediatrics COVID-19 Leadership Award, mentoring a trainee award, and teaching division awards in 2021.

Megan L. Curran

Megan L. Curran, MD, MPH, grew up in suburban Kansas City, went to Stanford University undergraduate, Michigan State University College of Human Medicine, Miami Children’s Hospital for residency and completed rheumatology fellowship at University of California San Francisco. She is the pediatric rheumatology fellowship director and co-chair of the pediatric fellowship programs at University of Colorado. Her clinical interests are juvenile inflammatory myopathy and systemic sclerosis. She researches competency-based education and assessment at the pediatric fellowship level. She is an avid animal lover and enjoys traveling with her husband Adam, a math professor at University of Colorado Denver, especially to places where there are exotic animals or tropical landscapes. They enjoy hiking Colorado trails with their pit bull mix Hazel and Greater Swiss Mountain Dog Greta.

Angela S. Czaja

Angela S. Czaja, MD PhD, is an Associate Professor of Pediatrics at the University of Colorado School of Medicine and the Director of the Pediatric Critical Care Medicine Fellowship. She received her BA and MD at the University of Pennsylvania. She completed her pediatrics residency at the Children’s Hospital of Philadelphia and pediatric critical care fellowship at Seattle Children’s Hospital. Dr. Czaja has been active member in the graduate medical education community in Colorado and nationally, including serving as a representative on the Subspecialty Pediatrics Investigator Network and Council of Pediatric Subspecialties and a PCCM sub-board member for the American Board of Pediatrics. Her areas of educational scholarly interest include leadership and professional development and ensuring diversity, equity and inclusion within medical education.

David A. Turner

David A. Turner, MD, is the Vice President for Competency-Based Medical Education (CBME) at the American Board of Pediatrics. He is also a Consulting Professor in the Department of Pediatrics and Division of Pediatric Critical Care at Duke Children’s Hospital. Dr. Turner attended medical school at Baylor College of Medicine in Houston, TX, and he also completed internship, residency, and a year as chief resident in pediatrics at Baylor and Texas Children’s Hospital. He then completed his fellowship in Pediatric Critical Care at Boston Children’s Hospital. Over the course of his career, Dr. Turner has held a number of local, regional, and national education leadership roles prior to transitioning to his current role at the American Board of Pediatrics in September of 2020. In this role, he is committed to helping lead a thoughtful transition to a competency-based approach to learning and assessment across the education continuum in pediatrics.

Pnina Weiss

Pnina Weiss, MD, MHPE, is a Professor and Vice Chair for Education in the Department of Pediatrics at the Yale School of Medicine. She received her BA from Barnard College and her MD degree from Case Western Reserve School of Medicine. She completed her pediatric residency and fellowships in Pediatric Critical Care, Pulmonology and Sleep Medicine at Yale. She has a strong interest in faculty development and advocacy for subspecialty and pulmonology program directors and training programs. She has served in leadership roles in the Association of Pediatric Program Directors, Pediatric Pulmonary Training Directors Association and the Council for Pediatric Subspecialties. She also serves on the Steering Committee for the Subspecialty Pediatrics Investigator Network. In collaboration with the American Board of Pediatrics, she co-authored the Pediatric Pulmonology entrustable professional activities (EPAs). Her work has focused on fellowship training including EPAs, scholarly activity training, recruitment, and funding. She currently serves as editor of the American Academy of Pediatrics PREP Pulmonology Self-Assessment.

Richard Mink

Richard Mink, MD, MACM, is a Professor of Pediatrics at the David Geffen School of Medicine at UCLA and Director of the Pediatric Critical Care Medicine Fellowship at Harbor-UCLA Medical Center in Torrance, CA. He received his BA from Franklin and Marshall College and his MD from Washington University (St. Louis). He completed his pediatric residency, chief residency and critical care fellowship at Children’s National Medical Center and a research fellowship at the Naval Medical Research Institute. In 2010, he completed a Masters in Academic Medicine at USC. Dr. Mink has extensive experience in medical education. He is a member of the Association of Pediatric Program Director’s (APPD) Longitudinal Educational Assessment Research Network Research Advisory and Proposal Review committees, a former member of the ACGME Review Committee for Pediatrics and is on the faculty of APPD’s Leadership in Educational Academic Development program. He is the founder and director of the Subspecialty Pediatrics Investigator Network as well as a founding member of another medical education research network, Educators in Pediatric Intensive Care. Dr. Mink’s main research interest is in assessment in graduate medical education, particularly the use of Entrustable Professional Activities. His other interests include giving feedback and teaching and assessing professionalism.