Graduating residents' readiness for unsupervised practice

Daniel J. Schumacher; Catherine Michelson; Ariel Winn; Duncan Henry; Meghan O'Connor; Su-Ting T. Li; Robyn J. Blair; Maria Velazquez-Campbell; Margaret J. Kihlstrom; Emily Borman-Shoap; Keith Ponitz; Joselyn Salvador-Sison; Benjamin Kinnear; David A. Turner; Abigail Martini; Heather L. Burrows; Rita Patel; Lauren M. Newhall; Rachel Osborn; Mia Mallory; Johannah M. Scheurer; Matthew Grant; Ross E. Myers; Elena C. Griego; Svetlana Kravtchenko; Shivika Jain; Thao Vu; Alan Schwartz

doi:10.1542/peds.2024-070307

Graduating residents' readiness for unsupervised practice

Daniel J. Schumacher, Catherine Michelson, Ariel Winn, Duncan Henry, Meghan O'Connor, Su-Ting T. Li, Robyn J. Blair, Maria Velazquez-Campbell, Margaret J. Kihlstrom, Emily Borman-Shoap, Keith Ponitz, Joselyn Salvador-Sison, Benjamin Kinnear, David A. Turner, Abigail Martini, Heather L. Burrows, Rita Patel, Lauren M. Newhall, Rachel Osborn, Mia MalloryJohannah M. Scheurer, Matthew Grant, Ross E. Myers, Elena C. Griego, Svetlana Kravtchenko, Shivika Jain, Thao Vu, Alan Schwartz

Advocate Health - Midwest

Research output: Contribution to journal › Article

Abstract

Objective: This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).

Methods: At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.

Results: Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).

Conclusion: While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.

Original language	American English
Journal	Pediatrics
DOIs	https://doi.org/10.1542/peds.2024-070307
Status	Published - Apr 9 2025

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Cite this

Schumacher, D. J., Michelson, C., Winn, A., Henry, D., O'Connor, M., Li, S.-T. T., Blair, R. J., Velazquez-Campbell, M., Kihlstrom, M. J., Borman-Shoap, E., Ponitz, K., Salvador-Sison, J., Kinnear, B., Turner, D. A., Martini, A., Burrows, H. L., Patel, R., Newhall, L. M., Osborn, R., ... Schwartz, A. (2025). Graduating residents' readiness for unsupervised practice. Pediatrics. https://doi.org/10.1542/peds.2024-070307

Schumacher, DJ, Michelson, C, Winn, A, Henry, D, O'Connor, M, Li, S-TT, Blair, RJ, Velazquez-Campbell, M, Kihlstrom, MJ, Borman-Shoap, E, Ponitz, K, Salvador-Sison, J, Kinnear, B, Turner, DA, Martini, A, Burrows, HL, Patel, R, Newhall, LM, Osborn, R, Mallory, M, Scheurer, JM, Grant, M, Myers, RE, Griego, EC, Kravtchenko, S, Jain, S, Vu, T & Schwartz, A 2025, 'Graduating residents' readiness for unsupervised practice', Pediatrics. https://doi.org/10.1542/peds.2024-070307

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title = "Graduating residents' readiness for unsupervised practice",

abstract = "Objective: This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).Methods: At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.Results: Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).Conclusion: While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.",

author = "Schumacher, {Daniel J.} and Catherine Michelson and Ariel Winn and Duncan Henry and Meghan O'Connor and Li, {Su-Ting T.} and Blair, {Robyn J.} and Maria Velazquez-Campbell and Kihlstrom, {Margaret J.} and Emily Borman-Shoap and Keith Ponitz and Joselyn Salvador-Sison and Benjamin Kinnear and Turner, {David A.} and Abigail Martini and Burrows, {Heather L.} and Rita Patel and Newhall, {Lauren M.} and Rachel Osborn and Mia Mallory and Scheurer, {Johannah M.} and Matthew Grant and Myers, {Ross E.} and Griego, {Elena C.} and Svetlana Kravtchenko and Shivika Jain and Thao Vu and Alan Schwartz",

year = "2025",

month = apr,

day = "9",

doi = "10.1542/peds.2024-070307",

language = "American English",

journal = "Pediatrics",

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TY - JOUR

T1 - Graduating residents' readiness for unsupervised practice

AU - Schumacher, Daniel J.

AU - Michelson, Catherine

AU - Winn, Ariel

AU - Henry, Duncan

AU - O'Connor, Meghan

AU - Li, Su-Ting T.

AU - Blair, Robyn J.

AU - Velazquez-Campbell, Maria

AU - Kihlstrom, Margaret J.

AU - Borman-Shoap, Emily

AU - Ponitz, Keith

AU - Salvador-Sison, Joselyn

AU - Kinnear, Benjamin

AU - Turner, David A.

AU - Martini, Abigail

AU - Burrows, Heather L.

AU - Patel, Rita

AU - Newhall, Lauren M.

AU - Osborn, Rachel

AU - Mallory, Mia

AU - Scheurer, Johannah M.

AU - Grant, Matthew

AU - Myers, Ross E.

AU - Griego, Elena C.

AU - Kravtchenko, Svetlana

AU - Jain, Shivika

AU - Vu, Thao

AU - Schwartz, Alan

PY - 2025/4/9

Y1 - 2025/4/9

N2 - Objective: This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).Methods: At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.Results: Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).Conclusion: While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.

AB - Objective: This study sought to determine whether graduating residents were deemed ready for unsupervised practice for each of the 17 general pediatrics entrustable professional activities (EPAs).Methods: At the end of the 2021-22, 2022-23, and 2023-24 academic years, the authors collected entrustment-supervision levels assigned by clinical competency committees for graduating residents from pediatric and medicine/pediatrics residency training programs to determine readiness for unsupervised practice at the time of graduation. They did this for each of the general pediatrics EPAs and examined the levels reported to determine the proportion of residents ready for unsupervised practice on each EPA and on all EPAs. They compared rates of readiness by academic year using a mixed-effects logistic regression model.Results: Across all EPAs, 33 190 total entrustment-supervision levels were reported for 2276 graduating pediatrics residents, and 2607 entrustment-supervision levels were reported for 168 graduating medicine/pediatrics residents. There were no EPAs in which programs reported more than 89% of residents as ready for unsupervised practice at the time of graduation. Only 31.3% of graduating residents with observations on all EPAs (414/1322) were deemed ready for unsupervised practice for all EPAs. Graduating medicine/pediatrics residents were more likely than pediatrics residents to be deemed ready for all EPAs (P = .002). Across study years, the rates of readiness at graduation for all EPAs rose from 18.0% to 38.5% (linear contrast P < .001).Conclusion: While there are reasons beyond actual resident readiness that may contribute, this study highlights a gap in readiness for unsupervised practice at the time of graduation.

U2 - 10.1542/peds.2024-070307

DO - 10.1542/peds.2024-070307

M3 - Article

C2 - 40199502

JO - Pediatrics

JF - Pediatrics

ER -