Using Entrustable Professional Activities to Make Reliable Overall Entrustment Decisions About Pediatric Residents

Daniel J. Schumacher; Daniel J. Sklansky; Brian Rissmiller; Lynn Thoreson; Linda Waggoner-Fountain; Rajat Pareek; Sue Poynter; Ariel Winn; Catherine Michelson; Benjamin Kinnear; David A. Turner; Leah S. Millstein; Jennifer Di Rocco; Kelsie Avants; Joanna Lewis; Pavan Srivastava; Erin L. Giudice; Michelle Arandes; Sylvia Yeh; Alan Schwartz; Ann Burke

doi:10.1093/acamed/wvaf001

Using Entrustable Professional Activities to Make Reliable Overall Entrustment Decisions About Pediatric Residents

Daniel J. Schumacher
, Daniel J. Sklansky
, Brian Rissmiller
, Lynn Thoreson
, Linda Waggoner-Fountain
, Rajat Pareek
, Sue Poynter
, Ariel Winn
, Catherine Michelson
, Benjamin Kinnear
, David A. Turner
, Leah S. Millstein
, Jennifer Di Rocco
, Kelsie Avants
, Joanna Lewis
, Pavan Srivastava
, Erin L. Giudice
, Michelle Arandes
, Sylvia Yeh
, Alan Schwartz

Ann Burke

Pediatrics

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose

Entrustable professional activities (EPAs) detail essential activities within a given specialty. Although 17 general pediatrics EPAs have been defined, it is not known how many are needed to make high-reliability overall entrustment decisions about resident readiness for practice at the time of graduation and initial certification. This study sought to determine how many general pediatrics EPAs are needed.
Method

During the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, the authors collected entrustment-supervision levels, determined by clinical competency committees biannually, for the 17 general pediatrics EPAs for residents at 48 U.S. pediatric residency training programs. Midyear reports were collected between November and January of each year, and end-of-year reports were collected between May and July. The authors conducted generalizability and decision studies to determine the number of EPAs needed to make a reliable overall entrustment decision.
Results

A total of 166,077 individual entrustment-supervision levels were collected for 4,250 pediatric residents across the 17 general pediatrics EPAs. Across all data reporting cycles, the authors found that assessing 6 EPAs yields a generalizability coefficient of 0.8 and assessing 12 EPAs yields a generalizability coefficient of 0.9. However, results differed for midyear compared with end-of-year data collection timepoints as well as by postgraduate year. At graduation, 9 to 13 EPAs are needed to make a highly reliable (generalizability coefficient of 0.9) overall decision about degree of entrustment for unsupervised practice.
Conclusions

This study provides rich insight into the number of EPAs needed to make reliable entrustment decisions about resident readiness to provide patient care. Although readiness can be determined with as few as 9 general pediatrics EPAs (an assessment task), more may be needed to inform a comprehensive curriculum that ensures focus in all areas important to developing general pediatricians during residency training (a curricular task).

Original language	American English
Pages (from-to)	79-85
Journal	Academic Medicine
Volume	101
Issue number	1
DOIs	https://doi.org/10.1093/acamed/wvaf001
State	Published - Jan 2026

Keywords

entrustable professional activities
resident assessment
graduate medical education
competency-based medical education

Disciplines

Pediatrics
Medical Education

Access to Document

10.1093/acamed/wvaf001License: Other

Cite this

Schumacher, D. J., Sklansky, D. J., Rissmiller, B., Thoreson, L., Waggoner-Fountain, L., Pareek, R., Poynter, S., Winn, A., Michelson, C., Kinnear, B., Turner, D. A., Millstein, L. S., Di Rocco, J., Avants, K., Lewis, J., Srivastava, P., Giudice, E. L., Arandes, M., Yeh, S., ... Burke, A. (2026). Using Entrustable Professional Activities to Make Reliable Overall Entrustment Decisions About Pediatric Residents. Academic Medicine, 101(1), 79-85. https://doi.org/10.1093/acamed/wvaf001

Schumacher, DJ, Sklansky, DJ, Rissmiller, B, Thoreson, L, Waggoner-Fountain, L, Pareek, R, Poynter, S, Winn, A, Michelson, C, Kinnear, B, Turner, DA, Millstein, LS, Di Rocco, J, Avants, K, Lewis, J, Srivastava, P, Giudice, EL, Arandes, M, Yeh, S, Schwartz, A & Burke, A 2026, 'Using Entrustable Professional Activities to Make Reliable Overall Entrustment Decisions About Pediatric Residents', Academic Medicine, vol. 101, no. 1, pp. 79-85. https://doi.org/10.1093/acamed/wvaf001

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title = "Using Entrustable Professional Activities to Make Reliable Overall Entrustment Decisions About Pediatric Residents",

abstract = "Purpose Entrustable professional activities (EPAs) detail essential activities within a given specialty. Although 17 general pediatrics EPAs have been defined, it is not known how many are needed to make high-reliability overall entrustment decisions about resident readiness for practice at the time of graduation and initial certification. This study sought to determine how many general pediatrics EPAs are needed. Method During the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, the authors collected entrustment-supervision levels, determined by clinical competency committees biannually, for the 17 general pediatrics EPAs for residents at 48 U.S. pediatric residency training programs. Midyear reports were collected between November and January of each year, and end-of-year reports were collected between May and July. The authors conducted generalizability and decision studies to determine the number of EPAs needed to make a reliable overall entrustment decision. Results A total of 166,077 individual entrustment-supervision levels were collected for 4,250 pediatric residents across the 17 general pediatrics EPAs. Across all data reporting cycles, the authors found that assessing 6 EPAs yields a generalizability coefficient of 0.8 and assessing 12 EPAs yields a generalizability coefficient of 0.9. However, results differed for midyear compared with end-of-year data collection timepoints as well as by postgraduate year. At graduation, 9 to 13 EPAs are needed to make a highly reliable (generalizability coefficient of 0.9) overall decision about degree of entrustment for unsupervised practice. Conclusions This study provides rich insight into the number of EPAs needed to make reliable entrustment decisions about resident readiness to provide patient care. Although readiness can be determined with as few as 9 general pediatrics EPAs (an assessment task), more may be needed to inform a comprehensive curriculum that ensures focus in all areas important to developing general pediatricians during residency training (a curricular task).",

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

author = "Schumacher, \{Daniel J.\} and Sklansky, \{Daniel J.\} and Brian Rissmiller and Lynn Thoreson and Linda Waggoner-Fountain and Rajat Pareek and Sue Poynter and Ariel Winn and Catherine Michelson and Benjamin Kinnear and Turner, \{David A.\} and Millstein, \{Leah S.\} and \{Di Rocco\}, Jennifer and Kelsie Avants and Joanna Lewis and Pavan Srivastava and Giudice, \{Erin L.\} and Michelle Arandes and Sylvia Yeh and Alan Schwartz and Ann Burke",

note = "Ann Burke served as Site Principal investigator at Wright State University/Dayton Children{\textquoteright}s Hospital",

year = "2026",

month = jan,

doi = "10.1093/acamed/wvaf001",

language = "American English",

volume = "101",

pages = "79--85",

journal = "Academic Medicine",

number = "1",

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TY - JOUR

T1 - Using Entrustable Professional Activities to Make Reliable Overall Entrustment Decisions About Pediatric Residents

AU - Schumacher, Daniel J.

AU - Sklansky, Daniel J.

AU - Rissmiller, Brian

AU - Thoreson, Lynn

AU - Waggoner-Fountain, Linda

AU - Pareek, Rajat

AU - Poynter, Sue

AU - Winn, Ariel

AU - Michelson, Catherine

AU - Kinnear, Benjamin

AU - Turner, David A.

AU - Millstein, Leah S.

AU - Di Rocco, Jennifer

AU - Avants, Kelsie

AU - Lewis, Joanna

AU - Srivastava, Pavan

AU - Giudice, Erin L.

AU - Arandes, Michelle

AU - Yeh, Sylvia

AU - Schwartz, Alan

AU - Burke, Ann

N1 - Ann Burke served as Site Principal investigator at Wright State University/Dayton Children’s Hospital

PY - 2026/1

Y1 - 2026/1

N2 - Purpose Entrustable professional activities (EPAs) detail essential activities within a given specialty. Although 17 general pediatrics EPAs have been defined, it is not known how many are needed to make high-reliability overall entrustment decisions about resident readiness for practice at the time of graduation and initial certification. This study sought to determine how many general pediatrics EPAs are needed. Method During the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, the authors collected entrustment-supervision levels, determined by clinical competency committees biannually, for the 17 general pediatrics EPAs for residents at 48 U.S. pediatric residency training programs. Midyear reports were collected between November and January of each year, and end-of-year reports were collected between May and July. The authors conducted generalizability and decision studies to determine the number of EPAs needed to make a reliable overall entrustment decision. Results A total of 166,077 individual entrustment-supervision levels were collected for 4,250 pediatric residents across the 17 general pediatrics EPAs. Across all data reporting cycles, the authors found that assessing 6 EPAs yields a generalizability coefficient of 0.8 and assessing 12 EPAs yields a generalizability coefficient of 0.9. However, results differed for midyear compared with end-of-year data collection timepoints as well as by postgraduate year. At graduation, 9 to 13 EPAs are needed to make a highly reliable (generalizability coefficient of 0.9) overall decision about degree of entrustment for unsupervised practice. Conclusions This study provides rich insight into the number of EPAs needed to make reliable entrustment decisions about resident readiness to provide patient care. Although readiness can be determined with as few as 9 general pediatrics EPAs (an assessment task), more may be needed to inform a comprehensive curriculum that ensures focus in all areas important to developing general pediatricians during residency training (a curricular task).

AB - Purpose Entrustable professional activities (EPAs) detail essential activities within a given specialty. Although 17 general pediatrics EPAs have been defined, it is not known how many are needed to make high-reliability overall entrustment decisions about resident readiness for practice at the time of graduation and initial certification. This study sought to determine how many general pediatrics EPAs are needed. Method During the 2021 to 2022, 2022 to 2023, and 2023 to 2024 academic years, the authors collected entrustment-supervision levels, determined by clinical competency committees biannually, for the 17 general pediatrics EPAs for residents at 48 U.S. pediatric residency training programs. Midyear reports were collected between November and January of each year, and end-of-year reports were collected between May and July. The authors conducted generalizability and decision studies to determine the number of EPAs needed to make a reliable overall entrustment decision. Results A total of 166,077 individual entrustment-supervision levels were collected for 4,250 pediatric residents across the 17 general pediatrics EPAs. Across all data reporting cycles, the authors found that assessing 6 EPAs yields a generalizability coefficient of 0.8 and assessing 12 EPAs yields a generalizability coefficient of 0.9. However, results differed for midyear compared with end-of-year data collection timepoints as well as by postgraduate year. At graduation, 9 to 13 EPAs are needed to make a highly reliable (generalizability coefficient of 0.9) overall decision about degree of entrustment for unsupervised practice. Conclusions This study provides rich insight into the number of EPAs needed to make reliable entrustment decisions about resident readiness to provide patient care. Although readiness can be determined with as few as 9 general pediatrics EPAs (an assessment task), more may be needed to inform a comprehensive curriculum that ensures focus in all areas important to developing general pediatricians during residency training (a curricular task).

KW - entrustable professional activities

KW - resident assessment

KW - graduate medical education

KW - competency-based medical education

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DO - 10.1093/acamed/wvaf001

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