Many Pediatric Subspecialty Fellows Are Not Ready to Graduate From Fellowship in 2 Years

Abstract

Background and objectives: The American Board of Pediatrics requires that proposed changes to the duration of pediatric subspecialty training must include a framework for competency assessment with a measurement component. We analyzed the clinical Entrustable Professional Activity (EPA) level of supervision ratings across 3-year pediatric fellowships to determine if trainees met the minimum thresholds for graduation after 2 years of fellowship training.

Methods: From spring 2019 through spring 2022, Clinical Competency Committees (CCCs) reported fellow supervision level ratings for all clinical EPAs, fellowship program directors (FPDs) assessed the scholarship EPA supervision level, and fellows self-reported their required level of supervision for all EPAs. Ratings were compared with minimum supervision level thresholds for fellow graduation previously identified by FPDs. We analyzed the proportion of fellows achieving these EPA supervision level thresholds after 2 and 3 years of training.

Results: CCCs reported ratings for 1538 second-year and 1505 third-year fellows. Fewer than 50% of fellows met clinical EPA supervision level thresholds for graduation after 2 years of training, increasing to 86%-100% across subspecialties at 3 years. Fellow self-assessment aligned well with CCC ratings. FPDs reported that 64%-68% of fellows across subspecialties met the scholarship EPA supervision level threshold for graduation after 2 years compared with 99%-100% at 3 years.

Conclusions: As pediatric fellowships are currently structured and using an EPA assessment framework, many trainees are not ready to graduate after 2 years.