Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics

Abstract

Objective: This study sought to determine differences in program-reported entrustable professional activity (EPA) entrustment-supervision levels based on residency program size.

Methods: At the end of the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, entrustment-supervision levels for the 17 General Pediatrics EPAs were determined by clinical competency committees for graduating pediatric residents at 48 pediatrics residency programs. Programs were categorized as small, medium, large, and very large. The authors fitted a main-effects mixed-effects logistic regression model to predict the likelihood that a graduating resident was deemed ready to execute each EPA without supervision, with program size and EPA as fixed effects and program as a random effect. A second model also included the interaction between program size and EPA as a predictor.

Results: A total of 33,335 entrustment-supervision levels were reported for 2285 graduating pediatrics residents. Small programs were more likely to report residents as ready for unsupervised practice than multiple larger-sized program groups for 4 EPAs (health screening, well newborn, recognize/refer surgical problems, and manage information).

Conclusions: Characteristics of small programs may lead them to be more likely to entrust graduating residents with unsupervised practice in certain areas.

Keywords: competency-based medical education; entrustable professional activities; resident assessment.