Using entrustable professional activities to assess graduation readiness in pediatric critical care

Using entrustable professional activities to assess graduation readiness in pediatric critical care

Turner D; Schwartz A; Carraccio C; Herman B; Mink R

Critical Care Medicine

2018

intensive care; Child; critically ill patient; expectation; Female; Human; Male; statistical analysis; Terminal Care; Validity

Learning Objectives: Assessing competence in pediatric critical care medicine (PCCM) training is challenging, and Entrustable Professional Activities (EPAs) were recently introduced to enhance the assessment process. There are 7 EPAs that define the tasks expected of pediatric subspecialists in independent practice, plus an additional 3 specifically created for PCCM. The Subspecialty Pediatrics Investigator Network (SPIN) previously published validity evidence for EPAs, and the current study is focused on using the 3 PCCM specific EPAs to identify the minimum level of supervision needed for graduating fellows. We hypothesized that the EPA framework will help establish consistent expectations for the minimum level of supervision required for graduation from PCCM fellowship. Methods: Level of supervision scales were developed by SPIN with input from each pediatric subspecialty. A survey asking about the minimum level of supervision for each EPA required for graduation was sent to all 67 PCCM fellowship program directors (FPD) of ACGME accredited programs. Statistical analysis used nonparametric methods. Results: Survey response rate was 87% (58/67) and respondents had a median duration of 5 years as a FPD. For the EPA describing the acute management of the critically ill patient, 71% felt that the minimum level for graduation was the ability to manage patients with indirect supervision, requiring discussion for only a few complex cases. Only 19% expected independent practice without supervision at graduation. For the PICU management EPA, 53% felt that graduating fellows should be trusted to lead without the supervisor present but would require coaching to improve member and team performance, and only 3% felt the target for this EPA was independent practice. For providing end of life care, 50% felt that fellows should be trusted to be indirectly supervised with coaching to manage a few complex issues, while only 16% expected independent practice. The anticipated minimum level of supervision at graduation was different across the three EPAs (p < 0.05). Conclusions: Most PCCM FPDs do not expect fellows to be fully prepared to practice independently at the time of graduation. Additional investigation is needed to further standardize expectations across programs and it is important to have an infrastructure to support and supervise new graduates as they enter independent practice.

2018

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