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Schwartz A, Borman-Shoap E, Carraccio C, et al. Learner Levels of Supervision Across the Continuum of Pediatrics Training. Acad Med. 2021;96(7):S42-S49doi: 10.1097/ACM.0000000000004095.
Schwartz, A., Borman-Shoap, E., Carraccio, C., Herman, B., Hobday, P. M., Kaul, P., Long, M., O'Connor, M., Mink, R., Schumacher, D. J., Turner, D. A., & West, D. C. (2021). Learner Levels of Supervision Across the Continuum of Pediatrics Training. Academic medicine : journal of the Association of American Medical Colleges, 96(7), S42-S49. https://doi.org/10.1097/ACM.0000000000004095
Schwartz, Alan, et al. "Learner Levels of Supervision Across the Continuum of Pediatrics Training." Academic medicine : journal of the Association of American Medical Colleges vol. 96,7 (2021): S42-S49. doi: https://doi.org/10.1097/ACM.0000000000004095
Schwartz A, Borman-Shoap E, Carraccio C, Herman B, Hobday PM, Kaul P, Long M, O'Connor M, Mink R, Schumacher DJ, Turner DA, West DC. Learner Levels of Supervision Across the Continuum of Pediatrics Training. Acad Med. 2021 Jul 01;96(7):S42-S49. doi: 10.1097/ACM.0000000000004095. PMID: 34183601.
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Acad Med. 2021 Jul 01;96(7):S42-S49. doi: 10.1097/ACM.0000000000004095.

Learner Levels of Supervision Across the Continuum of Pediatrics Training.

Academic medicine : journal of the Association of American Medical Colleges

Alan Schwartz, Emily Borman-Shoap, Carol Carraccio, Bruce Herman, Patricia M Hobday, Paritosh Kaul, Michele Long, Meghan O'Connor, Richard Mink, Daniel J Schumacher, David A Turner, Daniel C West

Affiliations

  1. A. Schwartz is Michael Reese Endowed Professor of Medical Education and research professor, pediatrics, University of Illinois College of Medicine, Chicago, Illinois, and network director, Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), McLean, Virginia; ORCID: http://orcid.org/0000-0003-3809-6637.
  2. E. Borman-Shoap is associate professor, residency program director, and vice chair of education, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0001-7514-7793.
  3. C. Carraccio was vice president for competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, at the time the work was completed; ORCID: https://orcid.org/0000-0001-5473-8914.
  4. B. Herman is professor and vice chair of education, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
  5. P.M. Hobday is assistant professor and director, Education in Pediatrics Across the Continuum (EPAC), Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
  6. P. Kaul is professor and associate director, EPAC, Department of Pediatrics, University of Colorado, School of Medicine, Denver, Colorado; ORCID: https://orcid.org/0000-0003-4155-7406.
  7. M. Long is professor and director, EPAC, Department of Pediatrics, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-8399-5589.
  8. M. O'Connor is assistant professor and director, EPAC, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-5403-923X.
  9. R. Mink is professor of pediatrics, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, pediatric critical care fellowship program director, Harbor-UCLA Medical Center, Torrance, California, and director, APPD Subspecialty Pediatrics Investigator Network, McLean, Virginia; ORCID: http://orcid.org/0000-0002-7998-4713.
  10. D.J. Schumacher is associate professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452.
  11. D.A. Turner was associate professor, Division of Pediatric Critical Care, Department of Pediatrics, and associate director, Graduate Medical Education, Duke University Hospital and Health System, Durham, North Carolina, at the time the work was completed.
  12. D.C. West is professor and senior director of medical education, Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0909-4213.

PMID: 34183601 DOI: 10.1097/ACM.0000000000004095

Abstract

PURPOSE: To describe trajectories in level of supervision ratings for linked entrustable professional activities (EPAs) among pediatric learners in medical school, residency, fellowship.

METHOD: The authors performed secondary analyses of 3 linked datasets of level of supervision ratings for the Core EPAs for Entering Residency, the General Pediatrics EPAs, and the Subspecialty Pediatrics EPAs. After identifying 9 activities in common across training stages and aligning the level of entrustment-supervision scales across the datasets, piecewise ordinal and linear mixed effects models were fitted to characterize trajectories of supervision ratings.

RESULTS: Within each training period, learners were rated as needing less supervision over time in each activity. When transitioning from medical school to residency or during the first year of residency, learners were rated as needing greater supervision in activities related to patient management, teamwork, emergent care, and public health/QI than in earlier periods. When transitioning from residency to fellowship, learners were always rated as needing greater supervision than they had been accorded at the end of residency and sometimes even more than they had been accorded at the start of residency.

CONCLUSIONS: Although development over training is often imagined as continuous and monotonically increasing competence, this study provides empirical evidence supporting the idea that entrustment is a set of discrete decisions. The relaxation of supervision in training is not a linear process. Even with a seamless curriculum, supervision is tightly bound to the training setting. Several explanations for these findings are discussed.

Copyright © 2021 by the Association of American Medical Colleges.

References

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