Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics

Daniel J. Schumacher; Ariel S. Winn; Joni Hemond; Carol Lynn O'Dea; Karla L. Garcia; Ann E. Burke; Monique M. Naifeh; Jason Zurawick; Benjamin Kinnear; Catherine Michelson; David A. Turner; Abigail Martini; Alan Schwartz

doi:10.1016/j.acap.2025.102806

Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics

Daniel J. Schumacher^*, Ariel S. Winn, Joni Hemond, Carol Lynn O'Dea, Karla L. Garcia, Ann E. Burke, Monique M. Naifeh, Jason Zurawick, Benjamin Kinnear, Catherine Michelson, David A. Turner, Abigail Martini, Alan Schwartz

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Comment/debate › peer-review

Abstract

Objective: This study sought to determine differences in program-reported entrustable professional activity (EPA) entrustment-supervision levels based on residency program size. Methods: At the end of the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, entrustment-supervision levels for the 17 General Pediatrics EPAs were determined by clinical competency committees for graduating pediatric residents at 48 pediatrics residency programs. Programs were categorized as small, medium, large, and very large. The authors fitted a main-effects mixed-effects logistic regression model to predict the likelihood that a graduating resident was deemed ready to execute each EPA without supervision, with program size and EPA as fixed effects and program as a random effect. A second model also included the interaction between program size and EPA as a predictor. Results: A total of 33,335 entrustment-supervision levels were reported for 2285 graduating pediatrics residents. Small programs were more likely to report residents as ready for unsupervised practice than multiple larger-sized program groups for 4 EPAs (health screening, well newborn, recognize/refer surgical problems, and manage information). Conclusions: Characteristics of small programs may lead them to be more likely to entrust graduating residents with unsupervised practice in certain areas.

Original language	English (US)
Article number	102806
Journal	Academic Pediatrics
Volume	25
Issue number	4
DOIs	https://doi.org/10.1016/j.acap.2025.102806
State	Published - May 1 2025

Funding

We thank Anna Sombrio and Avery Ulrich (APPD LEARN) for their support of this study. Financial statement: This study was supported in full by the American Board of Pediatrics Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Board of Pediatrics or the American Board of Pediatrics Foundation.

Keywords

competency-based medical education
entrustable professional activities
resident assessment

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1016/j.acap.2025.102806

Cite this

Schumacher, D. J., Winn, A. S., Hemond, J., O'Dea, C. L., Garcia, K. L., Burke, A. E., Naifeh, M. M., Zurawick, J., Kinnear, B., Michelson, C., Turner, D. A., Martini, A., & Schwartz, A. (2025). Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics. Academic Pediatrics, 25(4), Article 102806. https://doi.org/10.1016/j.acap.2025.102806

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title = "Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics",

abstract = "Objective: This study sought to determine differences in program-reported entrustable professional activity (EPA) entrustment-supervision levels based on residency program size. Methods: At the end of the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, entrustment-supervision levels for the 17 General Pediatrics EPAs were determined by clinical competency committees for graduating pediatric residents at 48 pediatrics residency programs. Programs were categorized as small, medium, large, and very large. The authors fitted a main-effects mixed-effects logistic regression model to predict the likelihood that a graduating resident was deemed ready to execute each EPA without supervision, with program size and EPA as fixed effects and program as a random effect. A second model also included the interaction between program size and EPA as a predictor. Results: A total of 33,335 entrustment-supervision levels were reported for 2285 graduating pediatrics residents. Small programs were more likely to report residents as ready for unsupervised practice than multiple larger-sized program groups for 4 EPAs (health screening, well newborn, recognize/refer surgical problems, and manage information). Conclusions: Characteristics of small programs may lead them to be more likely to entrust graduating residents with unsupervised practice in certain areas.",

keywords = "competency-based medical education, entrustable professional activities, resident assessment",

author = "Schumacher, {Daniel J.} and Winn, {Ariel S.} and Joni Hemond and O'Dea, {Carol Lynn} and Garcia, {Karla L.} and Burke, {Ann E.} and Naifeh, {Monique M.} and Jason Zurawick and Benjamin Kinnear and Catherine Michelson and Turner, {David A.} and Abigail Martini and Alan Schwartz",

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year = "2025",

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doi = "10.1016/j.acap.2025.102806",

language = "English (US)",

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T1 - Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics

AU - Schumacher, Daniel J.

AU - Winn, Ariel S.

AU - Hemond, Joni

AU - O'Dea, Carol Lynn

AU - Garcia, Karla L.

AU - Burke, Ann E.

AU - Naifeh, Monique M.

AU - Zurawick, Jason

AU - Kinnear, Benjamin

AU - Michelson, Catherine

AU - Turner, David A.

AU - Martini, Abigail

AU - Schwartz, Alan

PY - 2025/5/1

Y1 - 2025/5/1

N2 - Objective: This study sought to determine differences in program-reported entrustable professional activity (EPA) entrustment-supervision levels based on residency program size. Methods: At the end of the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, entrustment-supervision levels for the 17 General Pediatrics EPAs were determined by clinical competency committees for graduating pediatric residents at 48 pediatrics residency programs. Programs were categorized as small, medium, large, and very large. The authors fitted a main-effects mixed-effects logistic regression model to predict the likelihood that a graduating resident was deemed ready to execute each EPA without supervision, with program size and EPA as fixed effects and program as a random effect. A second model also included the interaction between program size and EPA as a predictor. Results: A total of 33,335 entrustment-supervision levels were reported for 2285 graduating pediatrics residents. Small programs were more likely to report residents as ready for unsupervised practice than multiple larger-sized program groups for 4 EPAs (health screening, well newborn, recognize/refer surgical problems, and manage information). Conclusions: Characteristics of small programs may lead them to be more likely to entrust graduating residents with unsupervised practice in certain areas.

AB - Objective: This study sought to determine differences in program-reported entrustable professional activity (EPA) entrustment-supervision levels based on residency program size. Methods: At the end of the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, entrustment-supervision levels for the 17 General Pediatrics EPAs were determined by clinical competency committees for graduating pediatric residents at 48 pediatrics residency programs. Programs were categorized as small, medium, large, and very large. The authors fitted a main-effects mixed-effects logistic regression model to predict the likelihood that a graduating resident was deemed ready to execute each EPA without supervision, with program size and EPA as fixed effects and program as a random effect. A second model also included the interaction between program size and EPA as a predictor. Results: A total of 33,335 entrustment-supervision levels were reported for 2285 graduating pediatrics residents. Small programs were more likely to report residents as ready for unsupervised practice than multiple larger-sized program groups for 4 EPAs (health screening, well newborn, recognize/refer surgical problems, and manage information). Conclusions: Characteristics of small programs may lead them to be more likely to entrust graduating residents with unsupervised practice in certain areas.

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Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics

Abstract

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Keywords

ASJC Scopus subject areas

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