Competency-based advancement in medical education: outcomes of the Education in Pediatrics Across the Continuum (EPAC) project

Abstract – Purpose – Despite the movement toward competency-based medical education (CBME), most training programs in the United States still advance learners based on time-in-training rather than achievement of competency standards. The Education in Pediatrics Across the Continuum (EPAC) project sought to answer whether it is possible to make time-variable, competency-based advancement decisions by creating a program that spans undergraduate (UME) to graduate medical education (GME) to fellowship/practice. This article reports the outcomes of the EPAC project. Method – Each participating site (Universities of California-San Francisco, Colorado, Minnesota, and Utah) selected 4 consecutive cohorts and prospectively followed them from July 2013 to June 2023. Implementation allowed for site-variability but adhered to common design principles. The Core Entrustable Professional Activities (EPAs) for Entering Residency and the General Pediatrics EPAs were the competency frameworks. Each site convened a clinical competency committee every three to six months to determine readiness for learner transition from UME to GME and GME to practice/fellowship based on demonstrated competence. Results – Fifty-six learners enrolled in EPAC and forty-four (79%) completed the program as designed. The time required for each learner to demonstrate readiness for transition from UME to GME (mean 20.2 four-week blocks [SD 2.76], range 14.5-26) and GME to practice/fellowship (mean 5.8 six-month blocks, [SD 0.34], range 4.9-6.1) varied. EPAC participants’ educational outcomes were comparable to non-EPAC graduates at the same site, including Milestones ratings (B = 0.30, P = .21), first time pass rates for the American Board of Pediatrics initial certifying exam (93%, 95% CI 81%-98%), and attainment of fellowship or job placements after graduation. Conclusions – The outcomes of the EPAC project demonstrated the ability to make competency-based readiness-to-transition decisions for individual learners and is the first CBME program to span the UME/GME medical education continuum in the US. Lessons learned from the EPAC project have the potential to contribute to advancement efforts for CBME.