Association of American Medical Colleges Core Entrustable Professional Activities for Entering Residency: Resident and Attending Physician Perceived Supervisory Needs of New Interns

Abstract

Purpose: Interns enter internship needing to perform many duties expected of a physician. The Association of American Medical Colleges (AAMC) has outlined these expectations in the form of core entrustable professional activities (EPAs) that all graduating medical students should be expected to be able to perform on day one of residency without direct supervision.1 However, it is unclear how much supervision new interns actually need when performing these EPAs. Furthermore, attending physicians and residents may have different perceptions about interns’ need for supervision. Therefore, the purpose of this study was to examine how much supervision residents and attending physicians perceive new interns to need at the beginning of intern year when performing the EPAs, and to examine whether attending physicians and residents have different perceptions of how much supervision new interns need when performing these EPAs. Method: Four months into the 2014–2015 academic year, an anonymous and voluntary electronic survey was administered to attending physicians at Boston Children’s Hospital and Boston Medical Center, who supervise Boston Combined Residency Program (BCRP) pediatric interns on inpatient general pediatric services, asking them to rate the amount of supervision they perceive new interns to need when performing 11 of the AAMC EPAs. Answer options included “(1) Has knowledge; (2) May act under full supervision; (3) May act under moderate supervision; (4) May act independently; or (5) May act as a supervisor and instructor.” At the same time, a similar survey was administered to all BCRP residents asking them to rate how much supervision they felt they themselves needed at the beginning of their intern year when performing the same EPAs, with a similar response scale. For each EPA, the number and percentage of attending physicians and residents who selected one of the top three options, best correlating with the ability to perform the EPA without direct supervision, was calculated. Differences in these percentages between residents and attending physicians were also tested. Results: There were only five EPAs that the majority of attending physicians thought new interns could perform without direct supervision. For five of the EPAs, residents’ perceptions of their own abilities to perform the EPA independently as interns were significantly greater than the attending physician’s perceptions of interns’ abilities. For example, 90.8% of residents thought they were able to recommend and interpret common diagnostic and screening tests when they were interns without direct supervision, compared with only 29.6% of attending physicians (P < .001). Conclusions: Attending physicians and residents in a pediatric residency training program reported that new interns were not consistently able to perform the core EPAs that the AAMC has established as a goal for all new residents without direct supervision. Furthermore, residents perceived that new interns need less supervision than attending physicians.