Entrustable Professional Activities: Correlation of Entrustment Assessments of Pediatric Residents With Concurrent Subcompetency Milestones Ratings.

Abstract

In competency-based medical education, subcompetency milestones represent a theoretical stepwise description for a resident to move from the level of novice to expert. Despite their ubiquitous use in the assessment of residents, they were not designed for that purpose. Because entrustable professional activities (EPAs) require observable behaviors, they could serve as a potential link between clinical observation of residents and competency-based assessment. We hypothesized that global faculty-of-resident entrustment ratings would correlate with concurrent subcompetency milestones-based assessments. This prospective study evaluated the correlation between concurrent entrustment assessments and subcompetency milestones ratings. Pediatric residents were assessed in 4 core rotations (pediatric intensive care unit, neonatal intensive care unit, general inpatient, and continuity clinic) at 3 different residency training programs during the 2014-2015 academic year. Subcompetencies were mapped to rotation-specific EPAs, and shared assessments were utilized across the 3 programs. We compared 29 143 pairs of entrustment levels and corresponding subcompetency levels from 630 completed assessments. Pearson correlation coefficients demonstrated statistical significance for all pairs (P < .001). Multivariate linear regression models produced R-squared values that demonstrated strong correlation between mapped EPA levels and corresponding subcompetency milestones ratings (median R 2 = 0.81; interquartile range 0.73-0.83; P < .001). This study demonstrates a strong association between assessment of EPAs and subcompetency milestones assessment, providing a link between entrustment decisions and assessment of competence. Our data support creating resident assessment tools where multiple subcompetencies can be mapped and assessed by a smaller set of rotation-specific EPAs.