Achieving Entrustable Professional Activities During Fellowship

Early on in their practice, graduates of some fellowship programs may still require continued development of both clinical and nonclinical skills, new research suggests. The authors surveyed 660 U.S. fellowship program directors (FPDs) in 14 pediatric subspecialties through the Subspecialty Pediatrics Investigator Network between April and August 2017. Minimum supervision levels that FPDs required for graduation were compared with the level they expected of subspecialists for safe and effective practice within seven common pediatric subspecialty Entrustable Professional Activities (EPAs), which were developed to assess pediatric fellows. Across the EPAs, the FPDs did not require fellows to achieve the expected level of entrustment for graduation needed for subspecialists to practice. The least amount of supervision expected was for the EPAs consultation and handovers. Additionally, the average differences between supervision levels for graduation and practice were smaller for clinical EPAs compared with nonclinical EPAs. "Graduation readiness must be based on clear requirements, with alignment of FPD expectations and regulatory standards, to ensure quality care for patients," the authors conclude.

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