61. DO PEDIATRIC FELLOWS MEET THE EXPECTED LEVEL OF SUPERVISION AT GRADUATION

Background At the end of training, fellowship program directors (FPD) attest that graduating fellows are competent to practice without supervision, but there are no agreed upon criteria on which to base this decision. Entrustable Professional Activities (EPAs) may provide an approach to determine if fellows are meeting a set standard. We examined whether graduates from the pediatric fellowships are meeting the minimum level of supervision for 6/7 common subspecialty EPAs. Methods The Subspecialty Pediatrics Investigator Network (SPIN) recently surveyed FPDs (response rate 82%) asking them to identify the minimum level of supervision expected for a graduating fellow for the common pediatric subspecialty EPAs (table). Consensus for the expected level was set at the 80th percentile. Achievement of these levels was then examined using data from a previous SPIN study in which Clinical Competency Committees assigned a level of supervision for graduating fellows for each EPA using 5-level scales. The number of fellows who met the minimum levels was determined and differences among subspecialties examined. Results 331 graduating fellows of ∼1275 graduates (26%) were assessed. 91% (n=302) met minimum levels for all 6 EPAs, 5% (n=16) met 5 and 4% (n=13) met 4 or fewer. For the Consultation and Handover EPAs, 22 (7%) and 10 (3%), respectively, did not meet minimum levels and 23 (7%) did not meet levels for both. There were differences among the subspecialties (p Conclusions These data suggest that while most fellows are meeting the expected level of supervision for 6 common subspecialty EPAs at graduation, many are not. Of concern is that some still need direct supervision for consultation and handovers. There are also differences among the subspecialties. Further study is needed to determine the source of these differences.