Competency-based advancement in medical education: outcomes of the Education in Pediatrics Across the Continuum (EPAC) project
Year: 2025
Type: article
Abstract: PURPOSE: Despite the movement toward competency-based medical education (CBME), most training programs in the United States still advance learners based on time-in-training rather than achievement of competency standards. The Education in Pediatrics Across the Continuum (EPAC) project sought to answer whether it is possible to make time-variable, competency-based advancement decisions by creating a program that spans undergraduate (UME) to graduate medical education (GME) to fellowship/practice. This article reports the outcomes of the EPAC project. METHOD: Each participating site (Universities of California-San Francisco, Colorado, Minnesota, and Utah) selected 4 consecutive cohorts and prospectively followed them from July 2013 to June 2023. Implementation allowed for site-variability but adhered to common design principles. The Core Entrustable Professional Activities (EPAs) for Entering Residency and the General Pediatrics EPAs were the competency frameworks. Each site convened a clinical competency committee every three to six months to determine readiness for learner transition from UME to GME and GME to practice/fellowship based on demonstrated competence. RESULTS: Fifty-six learners enrolled in EPAC and forty-four (79%) completed the program as designed. The time required for each learner to demonstrate readiness for transition from UME to GME (mean 20.2 four-week blocks [SD 2.76], range 14.5-26) and GME to practice/fellowship (mean 5.8 six-month blocks, [SD 0.34], range 4.9-6.1) varied. EPAC participants' educational outcomes were comparable to non-EPAC graduates at the same site, including Milestones ratings (B = 0.30, P = .21), first time pass rates for the American Board of Pediatrics initial certifying exam (93%, 95% CI 81%-98%), and attainment of fellowship or job placements after graduation. CONCLUSIONS: The outcomes of the EPAC project demonstrated the ability to make competency-based readiness-to-transition decisions for individual learners and is the first CBME program to span the UME/GME medical education continuum in the US. Lessons learned from the EPAC project have the potential to contribute to advancement efforts for CBME.
Source: Academic Medicine
Authors: Meghan M O’Connor, Patricia M Hobday, Michele Long, Jennifer Soep, Alan Schwartz, Dorene F Balmer, Emily Borman-Shoap, Bruce E Herman, Janice L Hanson, J Lindsey Lane, John S Andrews, James F Bale, Jr, Sara M Buckelew, H Carrie Chen, Michael J Cullen, Tiffany Glasgow, Brian P Good, Duncan Henry, Katherine E Murray, Boyd F Richards, Adam Rosenberg, Carol Carraccio, Daniel C West, Robert Englander, Deborah E Powell, Education in Pediatrics Across the Continuum (EPAC) Study Group1, Sara M Buckelew, H Carrie Chen, Duncan Henry, Michele Long, Daniel C West, Janice L Hanson, Paritosh Kaul, J Lindsey Lane, Adam Rosenberg, Jennifer B Soep, John Andrews, Emily Borman-Shoap, Michael Cullen, Robert Englander, Katherine E Murray, Patricia M Hobday, Deborah E Powell, James F Bale, Ashley Boyington, Tiffany Glasgow, Brian P Good, Bruce E Herman, Meghan O’Connor, Boyd F Richards, Carol Aschenbrener, Dorene Balmer, Carol Carraccio, Alan Schwartz
Institutions: Primary Children's Hospital, University of Utah, University of Minnesota, University of California, San Francisco, University of Colorado Anschutz, University of Colorado Denver, University of Illinois Chicago, University of Pennsylvania, Washington University in St. Louis, American Medical Association, Kaiser Permanente Bernard J. Tyson School of Medicine, Children's Hospital of Philadelphia
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Awards: G1818500969, G6897147263
OpenAlex ID: W7141259307