Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment
Richard Mink, Carol Carraccio, Bruce E. Herman, Pnina Weiss, David Turner, Diane Stafford, Kathleen A. McGann, Jennifer C. Kesselheim, Deborah Hsu, Pamela High, Jill J. Fussell, Megan L. Curran, Patricia R. Chess, Cary G. Sauer, Sarah Pitts, Angela Myers, John D. Mahan, Christiane E.L. Dammann, Tandy Aye, Alan Schwartz, for the Subspecialty Pediatrics Investigator Network, Vinod Havalad, Joaquim Pinheiro, Elizabeth M. Alderman, Mamta Fuloria, Megan McCabe, Jay Mehta, Yolanda Rivas, Maris Rosenberg, Cara Doughty, Albert C. Hergenroeder, Arundhati S. Kale, YoungNa Lee‐Kim, Jennifer A. Rama, Phil Steuber, Bob Voigt, Karen Hardy, Samantha Johnston, Debra Boyer, Carrie Mauras, Alison Schonwald, Tanvi Sharma, Christine Barron, Penny Dennehy, Elizabeth Jacobs, Jennifer Welch, Deepak Kumar, Katherine Mason, Nancy Roizen, Jerri A. Rose, Brooke Bokor, Jennifer Chapman, Lowell H. Frank, Iman Sami, Jennifer Schuette, R. Esther Lutes, Stephanie Savelli, Rambod Amirnovin, Rula Harb, R. Kato, Karen Marzan, Roshanak Monzavi, Doug Vanderbilt, Lesley Doughty, Constance McAneney, Ward R. Rice, Lea E. Widdice, Fran Erenberg, Blanca E. Gonzalez, Deanna Adkins, Deanna Green, Aditee Narayan, Kyle J. Rehder, Joel Clingenpeel, Suzanne P. Starling, Heidi Karpen, Kelly Rouster‐Stevens, Jatinder Bhatia, John S. Fuqua, Jennifer Anders, Maria Trent, Rangasamy Ramanathan, Yona Nicolau, Allen J. Dozor, T. Bernard Kinane, Takara L. Stanley, Amulya Nageswara Rao, Meredith Bone, Lauren Camarda, Viday Heffner, Olivia Kim, Jay Nocton, Angela L. Rabbitt, Richard L. Tower, Michelle Amaya, Jennifer Jaroscak, James Kiger, Michelle M. Macias, Olivia Titus, Modupe Awonuga
Abstract
BACKGROUND: Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES: We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS: In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS: One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05). CONCLUSIONS: We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.