532 - Many Pediatric Subspecialty Fellows Do Not Achieve the Expected Minimum Level of Supervision for Graduation After Two Years of Training

Poster Number: 532
Publication Number: 532.190

Background: Pediatric fellowships are three years in duration with the exception of Hospital Medicine. Some have argued to shorten fellowship training from three to two years, potentially increasing the number of trainees pursuing these disciplines, thereby increasing the pediatric subspecialty workforce.

Objective: Using Entrustable Professional Activities (EPA) level of supervision (LOS), our aim was to examine when fellows met previously determined LOS thresholds expected for graduation for the clinical (Handovers, Consultation, and LeadTeam, and all subspecialty specific) and Scholarship EPAs.

Design/Methods: Each spring in 2019, 2020, 2021 and 2022, Clinical Competency Committees (CCC) provided LOS ratings for the clinical EPAs for their fellows using a 5-level scale with validity evidence. Similarly, fellowship program directors (FPDs) provided LOS ratings for the Scholarship EPA. Using previously determined minimum EPA LOS thresholds expected at fellowship graduation, we analyzed the proportion of fellows meeting these levels at the end of their 2nd and 3rd years of fellowship. We also analyzed these data assuming a fellow did not meet the threshold for one or for two clinical EPAs.

Results: The number of fellow EPA LOS ratings provided by CCCs and FPDs are shown in Table 1. Fewer than 40% (range 19-39%) of fellows across all subspecialties met the LOS levels for graduation for all clinical EPAs at the end of their 2nd fellowship year, while 86-100% met them at the end of their 3rd year (Figure 1). Including fellows who met the threshold for all but one EPA slightly improved the proportion meeting the minimum graduation levels at the end of the 2nd year (range 25-49% across subspecialties). Including those meeting the levels for all but two EPAs raised the probability further (range 38-51% across subspecialties.) For the Scholarship EPA, fewer than 70% (range 62-68%) of fellows met the expected level for graduation at the end of their 2nd year while 99-100% met it at the end of their 3rd year of fellowship (Figure 2).

Conclusion(s): The majority of pediatric subspecialty fellows do not meet the previously determined minimum LOS thresholds for clinical EPAs expected for graduation after two years of fellowship training. Allowing fellows to miss two clinical EPA LOS thresholds did not markedly improve graduation readiness at the end of year two. As fellowships are presently constructed and based on current requirements, reducing training time to two years would not produce subspecialists ready for independent practice and would not provide adequate time for scholarly endeavors.