57. A “DENVER DEVELOPMENTAL” VIEW OF RESIDENT PERFORMANCE USING AN EPA FRAMEWORK

Introduction The American Board of Pediatrics and pediatrics community developed entrustable professional activities (EPAs) defining the foundation of general pediatrics care. We sought to determine the developmental progression of pediatric residents across 3 years of training for the 17 General Pediatrics (GP) EPAs. Methods Over 3 academic years (2015-18), 22 geographically representative residency programs in the APPD LEARN used scales with 5 or 8 anchors, describing levels of supervision from direct to indirect to entrustment, to assess EPAs biannually. Interns were assessed only at the end of Year 1. We fit growth curves to ordinal supervision levels for all 17 EPAs together using a linear mixed model and developed “Denver Developmental” charts to display the proportion of learners who have reached each given level of supervision on each EPA based on the growth curves. Results Figure 1 illustrates examples of the developmental progression for 5 of the 17 EPAs. The graphic demonstrates where 25% (beginning of white box), 75% (where white and blue boxes meet), and 90% (end of blue box) of residents achieve each supervision level for the EPA with the highest ratings (handovers) and 4 EPAs with the lowest ratings (quality improvement, resuscitate/stabilize, behavioral/mental health, and transition to adult care) across 3 years of training. Some levels were achieved by all residents by the end of the intern year (e.g., levels 1-3 for EPA 16, handovers). Most EPAs had one or more advanced levels where the 25%, 75%, or 90% data extended beyond the end of training. In those instances, the percent of residents achieving these levels is indicated on the right-hand side of Figure 1 (e.g., 12% of residents achieved level 8 for EPA 8, transition to adult care, by the end of training). Conclusion The GP EPA “Denver Developmental” progressions may help in early screening for underperforming residents. This is critical information for the learner and the program. For the former, providing feedback provides an opportunity for improvement and for the latter, if a number of learners are not progressing as expected this may indicate curricular gaps.