173 - Entrustable Professional Activities as a Measure of Trainee Confidence in the Care of Children with Medical Complexity

Publication Number: 173.4942

Joaquin Alfonso Villaruz, University of Colorado School of Medicine, Denver, CO, United States; Laura Lockwood, University of Colorado School of Medicine, Denver, CO, United States; Hannah Friedman, University of Colorado School of Medicine, Aurora, CO, United States; Sonja I. Ziniel, University of Colorado School of Medicine, Aurora, CO, United States; Alexandra Kilinsky, University of Colorado School of Medicine, Denver, CO, United States

Background: Children with Medical Complexity (CMC) are those with multiorgan, lifelong, chronic conditions that lead to functional limitations and high healthcare needs and/or utilization. CMC-related Entrustable Professional Activities (EPAs) illustrate a trainee’s readiness to independently care for CMC in practice. When employed within a curricular needs assessment, EPAs may facilitate curriculum design by focusing on essential competencies of CMC care.

Objective: Describe 1) resident and alumni confidence, 2) faculty level of entrustment of clinical decisions, and 3) curricular gaps related to care of CMC using an EPA-based, multi-stakeholder, curricular needs assessment within a large pediatric residency program.

Design/Methods: Participants composed of current residents, recent alumni, and faculty affiliated with a single pediatric residency program completed needs assessment surveys based on the 11 EPAs related to care of CMC (Table 1). Resident and alumni surveys measured their confidence in executing the EPAs, and faculty surveys measured likelihood to entrust these clinical tasks to senior residents. Resident and alumni confidence ratings were directly compared and juxtaposed to faculty’s entrustment levels.

Results: Eighteen residents, 41 recent alumni, and 19 faculty completed the needs assessments. Less than 50% of residents self-reported very/extremely high confidence for each CMC-related EPA (Figure 1). Similarly, faculty had low entrustment of the EPAs to be independently performed by senior residents (Figure 1). Overall, alumni reported increased confidence across all CMC-related EPAs compared to current residents; however, there were only 3 of 11 EPAs where >50% alumni felt very/extremely confident (Figure 1). A Fisher’s exact test to assess if confidence levels differed amongst alumni by years of clinical experience showed no significance.

Conclusion(s): This study identified that most pediatric residents and alumni are not confident in caring for CMC. While alumni were more confident overall across EPAs, confidence remained < 50% for the majority of EPAs, suggesting that clinical practice after graduation may not alone be sufficient to gain confidence in these areas. This EPA-based needs assessment serves as a helpful tool for identifying the most pertinent knowledge gaps amongst trainees and highlights target areas for future curriculum development. It may also give insight into opportunities for faculty development in their expertise and teaching of CMC-related EPAs. Future work will focus on designing and evaluating a CMC-focused curriculum to address the gaps identified in the current study.

Figure 1: Percentage of Very/Extremely Confident Residents (n=18) and Alumni (n=41) in Entrustable Professional Activities (EPAs) and Percentage of Faculty (n=19) Allowing Senior Residents to Practice Unsupervised or Teach EPAs
Legend: Grey - % Confident Residents; Light Gray - % Confident Alumni; Black - % Faculty Allowing Senior Residents to Practice Unsupervised or Teach the Skill.

Table 1: List of Entrustable Professional Activities (EPAs) in Complex Care
These Entrustable Professional Activities for Children with Medical Complexity (CMC) were designed by a national coalition of complex care providers as described in Huth, K., et al (2022). A Multistakeholder Approach to the Development of Entrustable Professional Activities in Complex Care. Academic pediatrics, 22(2), 184–189.