Use of entrustable professional activities for reliable overall entrustment decisions
Authors
Daniel J. Schumacher, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Daniel J. Sklansky, Department of Pediatrics, University of Wisconsin, Madison, WI, United States.
Brian Rissmiller, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Lynn Thoreson, Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, TX, United States.
Linda A. Waggoner-Fountain, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States.
Rajat Pareek, Department of Pediatrics, Michigan State University College of Human Medicine, Grand Rapids, MI, United States.
Sue E. Poynter, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Ariel S. Winn, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Catherine Michelson, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, United States.
Benjamin Kinnear, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
David A. Turner, American Board of Pediatrics, Chapel Hill, NC, United States.
Leah S. Millstein, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States.
Jennifer R. Di Rocco, Department of Pediatrics, University of Hawaii, Honolulu, HI, United States.
Kelsie Avants, Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, IL, United States.
Joanna Lewis, Advocate Health - MidwestFollow
Pavan Srivastava, Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, IL, United States.
Erin L. Giudice, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States.
Michelle Arandes, Department of Pediatrics, UT Health San Antonio Long School of Medicine, San Antonio, TX, United States.
Sylvia Yeh, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, United States.
Alan Schwartz, Department of Medical Education, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, United States.
Daniel J. Schumacher, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Daniel J. Sklansky, Department of Pediatrics, University of Wisconsin, Madison, WI, United States.
Brian Rissmiller, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Lynn Thoreson, Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, TX, United States.
Linda A. Waggoner-Fountain, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States.
Rajat Pareek, Department of Pediatrics, Michigan State University College of Human Medicine, Grand Rapids, MI, United States.
Sue E. Poynter, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Ariel S. Winn, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Catherine Michelson, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, United States.
Benjamin Kinnear, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
et al
Recommended Citation
Schumacher DJ, Sklansky DJ, Rissmiller B, et al. Use of entrustable professional activities for reliable overall entrustment decisions. Acad Med. Published online December 3, 2025. doi:10.1093/acamed/wvaf001
Abstract
Purpose: Entrustable professional activities (EPAs) detail essential activities within a given specialty. Although 17 general pediatrics EPAs have been defined, it is not known how many are needed to make high-reliability overall entrustment decisions about resident readiness for practice at the time of graduation and initial certification. This study sought to determine how many general pediatrics EPAs are needed.
Method: During the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, the authors collected entrustment-supervision levels, determined by clinical competency committees biannually, for the 17 general pediatrics EPAs for residents at 48 U.S. pediatric residency training programs. Midyear reports were collected between November and January of each year, and end-of-year reports were collected between May and July. The authors conducted generalizability and decision studies to determine the number of EPAs needed to make a reliable overall entrustment decision.
Results: A total of 166,077 individual entrustment-supervision levels were collected for 4,250 pediatric residents across the 17 general pediatrics EPAs. Across all data reporting cycles, the authors found that assessing 6 EPAs yields a generalizability coefficient of 0.8 and assessing 12 EPAs yields a generalizability coefficient of 0.9. However, results differed for midyear compared with end-of-year data collection timepoints as well as by postgraduate year. At graduation, 9 to 13 EPAs are needed to make a highly reliable (generalizability coefficient of 0.9) overall decision about degree of entrustment for unsupervised practice.
Conclusions: This study provides rich insight into the number of EPAs needed to make reliable entrustment decisions about resident readiness to provide patient care. Although readiness can be determined with as few as 9 general pediatrics EPAs (an assessment task), more may be needed to inform a comprehensive curriculum that ensures focus in all areas important to developing general pediatricians during residency training (a curricular task).Teaser text: This study sought to determine how many entrustable professional activities are necessary to make high reliability overall entrustment decisions about pediatric resident readiness for unsupervised practice.
Affiliations
Advocate Children's Hospital, Park Ridge