Pediatric Emergency Medicine Fellowship Program Directors' Viewpoint

Abstract

Objectives: Entrustable Professional Activities (EPAs) are essential tasks physicians perform within their professions. Entrustment levels that pediatric emergency medicine (PEM) fellowship program directors (FPDs) expect graduating fellows to achieve for PEM-specific and common pediatric subspecialty EPAs remain unreported. This study aims to determine minimum entrustment levels FPDs require fellows to achieve to graduate from fellowship and to compare FPD expectations for fellows versus practicing PEM physicians.Methods: Secondary analysis of PEM-specific data from a national multispecialty cross-sectional survey of pediatric subspecialty FPDs. For 6 PEM-specific and 7 common pediatric subspecialty EPAs, PEM FPDs indicated (1) minimum entrustment levels fellows should achieve by training completion, (2) whether they would allow a fellow to graduate below these minimum levels, and (3) minimum levels for safe and effective practice by PEM physicians. Minimum levels were defined as the level that more than 80% of FPDs would not drop below.Results: Sixty of 77 PEM FPDs (78%) completed the survey. Most respondents did not require fellows to achieve the highest level (level 5-no supervision) by graduation for any PEM-specific EPAs. The median level FPDs expected for practicing PEM physicians was 5 (trusted to perform without supervision) for EPAs 1 and 4 and level 4 (indirect supervision for complex cases) for the remaining PEM-specific EPAs. Minimum levels expected by FPDs for common subspecialty pediatric EPAs were lower for both groups.Conclusions: Most PEM FPDs indicated that they would graduate fellows before their achievement of the highest entrustment level for all EPAs. Most also indicated that they do not expect practicing PEM physicians to perform all EPAs without supervision. These findings indicate need for stakeholders to evaluate current structure and outcomes of PEM fellowship programs and for institutions and organizations to ensure adequate support in time and resources for ongoing learning for practicing PEM physicians.

Minimum Supervision Levels required for Pediatric Cardiology Fellowship graduation by Pediatric Cardiology Fellowship Program Directors

“…These reports are comparable to pediatric pulmonology and pediatric emergency medicine (PEM) subspecialties. [11,12]In both subspecialties, FPDs indicated that some graduating fellows might need some supervision during practice across all of their subspecialty-speci c EPAs. Additionally, Turner et al reported that FPDs would not require fellows to be able to practice without supervision for graduation for any of the seven common pediatric subspecialty EPAs.…”

“…The minimum level of supervision (LOS) was de ned as the LOS at which no more than 20% of FPDs would want a lower level, which is in agreement with other publications. [11,12,15] The differences in the LOS ratings at graduation and practice for each EPA were analyzed using the Wilcoxon signed-rank tests. The correlation between the number of fellows, years as PD, understanding of EPAs, whether the program uses EPAs, and whether the program participated in the previous SPIN study with graduation and entrustment levels were analyzed using Spearman's correlation.…”

“…These studies have highlighted a need to evaluate the structures and resources of their individual subspecialty training programs to prepare trainees to provide safe and effective care without supervision in practice. [11,12] This study aimed to explore the current opinions about pediatric cardiology (PC) speci c EPAs by PC FPDs to help establish consistent expectations for fellows at graduation from fellowship. [13]We hypothesized that the expectations from PC FPD for the minimum LOS for graduation would be lower than the minimum LOS for safe and effective practice.…”

Minimum Supervision Levels Required for Pediatric Cardiology Fellowship Graduation by Pediatric Cardiology Fellowship Program Directors

“…The minimum level of supervision (LOS) was defined as the LOS at which no more than 20% of FPDs would want a lower level, which is in agreement with other publications. [11,12,15] The differences in the LOS ratings at graduation and practice for each EPA were analyzed using the Wilcoxon signed-rank tests. The correlation between the number of fellows, years as PD, understanding of EPAs, whether the program uses EPAs, and whether the program participated in the previous SPIN study with graduation and entrustment levels were analyzed using Spearman's correlation.…”

“…These studies have highlighted a need to evaluate the structures and resources of their individual subspecialty training programs to help trainees provide safe and effective care without supervision in practice. [11,12] This study aimed to explore the current opinions about pediatric cardiology (PC) specific EPAs by PC FPDs to help establish consistent expectations for fellows at graduation from fellowship. [13]We hypothesized that the expectations from PC FPD for the minimum LOS for graduation would be lower than the minimum LOS for safe and effective practice.…”