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Learner Levels of Supervision Across the Continuum of Pediatrics Training. Acad Med 2021 Jul 01;96(7S):S42-S49



Pubmed ID




Scopus ID

2-s2.0-85109740031   5 Citations


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.

Author List

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


Paritosh Kaul MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Clinical Competence
Competency-Based Education
Education, Medical, Graduate
Education, Medical, Undergraduate
Fellowships and Scholarships
Internship and Residency