Pediatric Emergency Medicine Fellowship Program Directors' Viewpoint Minimum Levels of Entrustment for Graduating Fellows and Practicing Physicians to Perform the Subspecialty's Professional Activities

ObjectivesEntrustable 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.MethodsSecondary 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.ResultsSixty 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.ConclusionsMost 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.

Automated summary

This study aimed to determine the minimum entrustment levels expected by pediatric emergency medicine (PEM) fellowship program directors (FPDs) for both graduating fellows and practicing PEM physicians. The results showed that most PEM FPDs do not require fellows to achieve the highest entrustment level for any PEM-specific EPAs by graduation. Most FPDs also indicated that they do not expect practicing PEM physicians to perform all EPAs without supervision. These findings highlight the need for evaluation of PEM fellowship programs and ongoing support for practicing PEM physicians.