Learner Levels of Supervision Across the Continuum of Pediatrics Training

Alan Schwartz, Emily Borman-Shoap, Carol Carraccio, Bruce Herman, Patricia M. Hobday, Paritosh Kaul, Michele Long, Meghan O'Connor, Richard Mink, Daniel J. Schumacher, David A. Turner, Daniel C. West

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose To describe trajectories in level of supervision ratings for linked entrustable professional activities (EPAs) among pediatric learners in medical school, residency, fellowship. Method The authors performed secondary analyses of 3 linked datasets of level of supervision ratings for the Core EPAs for Entering Residency, the General Pediatrics EPAs, and the Subspecialty Pediatrics EPAs. After identifying 9 activities in common across training stages and aligning the level of entrustment-supervision scales across the datasets, piecewise ordinal and linear mixed effects models were fitted to characterize trajectories of supervision ratings. Results Within each training period, learners were rated as needing less supervision over time in each activity. When transitioning from medical school to residency or during the first year of residency, learners were rated as needing greater supervision in activities related to patient management, teamwork, emergent care, and public health/QI than in earlier periods. When transitioning from residency to fellowship, learners were always rated as needing greater supervision than they had been accorded at the end of residency and sometimes even more than they had been accorded at the start of residency. Conclusions Although development over training is often imagined as continuous and monotonically increasing competence, this study provides empirical evidence supporting the idea that entrustment is a set of discrete decisions. The relaxation of supervision in training is not a linear process. Even with a seamless curriculum, supervision is tightly bound to the training setting. Several explanations for these findings are discussed.

Original languageEnglish (US)
Pages (from-to)S42-S49
JournalAcademic Medicine
Issue number7 S
StatePublished - Jul 1 2021

Bibliographical note

Funding Information:
Funding/Support: This study was supported in part by a GEA National Grant Award to A. Schwartz. The data analyzed were generated in studies supported by the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN), the Subspecialty Pediatrics Investigator Network (SPIN, now APPD SPIN), the Education in Pediatrics Across the Continuum (EPAC) project of the Association of American Medical Colleges (AAMC), and the American Board of Pediatrics Foundation.

Publisher Copyright:
© Copyright by the Association of American Medical Colleges.


  • Clinical Competence
  • Competency-Based Education
  • Education, Medical, Graduate
  • Education, Medical, Undergraduate
  • Fellowships and Scholarships
  • Humans
  • Internship and Residency
  • Pediatrics/education

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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