Minimum Supervision Levels for Graduation and Practice: Pediatric Gastroenterology Fellowship Program Directors’ Perspective

Entrustable professional activities (EPAs) define key tasks expected of physicians. The entrustment levels that US pediatric gastroenterology (GI) fellowship program directors (FPDs) expect of graduating fellows remain unclear. This study aimed to identify the minimum entrustment levels FPDs expect for graduation and for safe and effective practice. We conducted a secondary analysis of GI data from a national multispecialty cross-sectional survey. FPDs reported the minimum entrustment level for fellows expected for graduation, whether they would graduate a fellow not meeting this level, and the minimum level for practice. A minimum entrustment level was defined as a level where at least 80% of FPDs would not allow a lower rating. Most FPDs did not require level 5 (unsupervised practice) for graduation or for practice. Instead, level 4 (indirect supervision with discussion of complex cases) was the most commonly required minimum for GI EPAs. When adjusted for FPD willingness to graduate fellows even if they did not meet the expected minimum, the level was 3 (direct supervision for complex cases) across all GI-specific EPAs. These findings underscore the potential need for ongoing mentorship, professional development, and continuing medical education after GI fellowship, particularly in the early practice period.