Clinical competency committee perceptions of entrustable professional activities and their value in assessing fellows: A qualitative study of pediatric subspecialty program directors

To examine the composition and processes of Clinical Competency Committees (CCCs) assigning entrustable professional activity (EPA) levels of supervision for pediatric subspecialty fellows and to examine fellowship program director (FPD) perspectives about using EPAs to determine fellows’ graduation readiness. A qualitative study was performed using one-on-one interviews with a purposeful sample of pediatric subspecialty FPDs to yield a thematic analysis. Semi-structured interview guides were used for participants who self-identified as EPA users or non-users. Inductive analysis and coding were performed on transcripts until theoretical sufficiency was attained. Twenty-eight FPDs were interviewed. There was significant variability in the composition and processes of CCCs across subspecialties. FPDs felt that CCCs intuitively understand what entrustment means, allowing for ease of application of level of supervision (LOS) scales and consensus. FPDs perceived that EPAs provided a global assessment of fellows and are one tool to determine graduation readiness. Although there was variability in the makeup and processes of CCCs across subspecialties, FPDs believe EPAs are intuitive and relatively easy to implement. Consensus can be reached easily using EPA-specific LOS scales focusing on entrustment. FPDs desire a better understanding of how EPAs should be used for graduation.

本研究旨在探讨为儿科亚专科进修医师委派可委派专业活动（entrustable professional activity, EPA）监督级别的临床能力委员会（Clinical Competency Committees, CCCs）的构成与运作流程，并调研专科培训项目主任（fellowship program director, FPD）对使用EPA判定进修医师毕业合格性的观点。本研究采用定性研究方法，对经目的性抽样选取的儿科亚专科FPD开展一对一访谈以开展主题分析。研究采用半结构化访谈提纲，受访对象为自我标识为EPA使用者或非使用者的人员。研究人员对访谈转录稿进行归纳分析与编码，直至达到理论饱和。本研究共访谈28名FPD。结果显示，不同亚专科的CCCs在构成与运作流程上存在显著异质性。FPD们认为，CCCs可直观理解委派权限的内涵，这使得监督级别（level of supervision, LOS）量表的应用与共识达成更为顺畅。FPD们认为，EPA可对进修医师进行整体评估，是判定其毕业合格性的工具之一。尽管不同亚专科的CCCs在构成与运作流程上仍存在异质性，但FPD们普遍认可EPA直观易懂且相对易于实施。采用聚焦委派权限的EPA专属LOS量表，可较为便捷地达成共识。FPD们希望进一步明确EPA在毕业合格性判定中的规范使用方式。