Graduating residents' readiness for unsupervised practice
Authors
Daniel J. Schumacher, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Catherine Michelson, Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois.
Ariel Winn, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Duncan Henry, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Meghan O'Connor, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Su-Ting T. Li, Department of Pediatrics, University of California Davis, Sacramento, California.
Robyn J. Blair, Department of Pediatrics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York.
Maria Velazquez-Campbell, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Margaret J. Kihlstrom, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Emily Borman-Shoap, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Keith Ponitz, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Joselyn Salvador-Sison, Department of Pediatrics, Icahn School of Medicine, New York, New York.
Benjamin Kinnear, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
David A. Turner, American Board of Pediatrics, Chapel Hill, North Carolina.
Abigail Martini, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Heather L. Burrows, Department of Pediatrics, The University of Michigan, Ann Arbor, Michigan.
Rita Patel, Jane Pauley Community Health Center, Indianapolis, Indiana.
Lauren M. Newhall, Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia.
Rachel Osborn, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
Mia Mallory, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Johannah M. Scheurer, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Matthew Grant, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
Ross E. Myers, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Elena C. Griego, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Svetlana Kravtchenko, Advocate Health - MidwestFollow
Shivika Jain, Ascension St Vincent/Peyton Manning Children's Hospital, Indianapolis, Indiana.
Thao Vu, Department of Pediatrics, University of Florida Health Shands Children's Hospital, Gainesville, Florida.
Alan Schwartz, Departments of Medical Education and Pediatrics, University of Illinois Chicago, Chicago, Illinois.
Recommended Citation
Schumacher DJ, Michelson C, Winn A, et al. Graduating Residents' Readiness for Unsupervised Practice. Pediatrics. 2025;155(5):e2024070307. doi:10.1542/peds.2024-070307
Abstract
Objective:This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).
Methods:At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.
Results:Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).
Conclusion:While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.
Affiliations
Advocate's Children's Hospital, Park Ridge