Level of supervision for the epas common to general pediatrics and the subspecialties decreases from residency to fellowship

Objectives To compare level of supervision (LOS) ratings of graduating pediatric residents with their assessments as fellows for the 5 Entrustable Professional Activities (EPAs) common to general pediatrics and the subspecialties and to determine if the difference between ratings from residency to fellowship is less for the QI and PRACTICE MANAGEMENT EPAs, since the skills needed to perform these may be less context-dependent. Methods We compared ratings of graduating residents with their assessments as fellows using LOS data from 2 sequential EPA studies. Results There were 65 ratings from 41 residents at the 1st fellow assessment. At graduation, most residents needed little to no supervision for all EPAs with 94% (61/65) of ratings level 4 or 5. In contrast, only 5/65 (8%) of the 1st fellow assessments were level 4 or 5. The ratings difference for the QI and PRACTICE MANAGEMENT EPAs was similar to the others. Conclusions LOS ratings for the EPAs common to generalists and subspecialists reset as residents become fellows. There was no evidence that the QI and PRACTICE MANAGEMENT EPAs are less context-dependent. This study provides additional validity evidence for using these LOS scales to assess trainees in pediatric residency and fellowship.