Pediatric Residents’ Readiness for Practice and Performance on the Initial Certifying Examination

OBJECTIVES: We examine the relationship between entrustable professional activity (EPA)-based assessments made by clinical competency committees at the conclusion of pediatric residency training and general pediatrics initial certifying examination performance. METHODS: Between 2015 and 2018, 21 residency programs evaluated residents' readiness to perform subsets of the 17 general pediatrics EPAs without supervision. These data were linked with scores from the American Board of Pediatrics General Pediatrics Initial Certifying Exam. Certifying exam performance for graduates deemed ready for unsupervised practice was compared with the exam performance of those not deemed ready. RESULTS: Of 934 graduates, 851 (91%) passed the initial certifying exam on their first attempt. Of these, 520 (61%) were deemed ready for unsupervised practice for all observed EPAs, and 331 (39%) were not. Of the 83 who failed on their first exam attempt, 43 (52%) were deemed ready for unsupervised practice for all observed EPAs, and 40 (48%) were not. CONCLUSIONS: Practice readiness assessment using the EPA framework does not correlate well with the passing of board exams. These assessments measure different, albeit overlapping, components necessary for the care of children. Continued effort is needed to determine how to integrate a competency-based approach that uses information from different sources to help make informed and defensible decisions regarding each individual's educational needs and ultimate readiness for practice into both training and certification processes.