In 2013, pediatric common subspecialty entrustable professional activities (EPAs) were developed in alignment with efforts to transition toward Competency Based Medical Education, a system in which trainees’ advancement is based on skill level and does not passively mirror time spent in training. In this competency-based system, pediatric fellowship program directors (FPDs) have been shown to graduate fellows who continue to require supervision in the common subspecialty EPAs. In this issue of Pediatrics, Weiss et al5 redemonstrate that FPDs graduate fellows who require ongoing supervision in the common subspecialty EPAs and newly establish that the degree of supervision required after graduation is more than FPDs would expect an attending physician subspecialist to need for safe and effective outcomes. These findings were consistent across subspecialities and bolstered by the study’s high survey response rate. Initial reactions to these findings may be concern, embarrassment, or frustration with current pediatric subspecialty fellowship training; after all, is not the point of fellowship training to develop competent fellows ready for independent practice?
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