Subspecialty PediatricsInvestigator Network

SPIN Steering CommitteeAdolescent Medicine Sarah PittsCardiology Gina Baffa & Shubhika SrivastavaChild Abuse Bruce HermanCritical Care Medicine David TurnerDevelopmental and Behavioral Pediatrics Jill Fussell & Pam HighEmergency Medicine Deb HsuEndocrinology Dianne Stafford & Tandy AyeGastroenterology Cary SauerHematology-Oncology Jennifer KesselheimInfectious Diseases Angie Myers & Kammy McGannNeonatology Christiane Dammann & Patricia ChessNephrology John MahanPulmonary Medicine Pnina WeissRheumatology Megan CurranAPPD LEARN Alan Schwartz*ABP Carol Carraccio*APPD Fellowship Committee Bruce Herman*CoPS Richard Mink*

*Board of Directors

SPIN’s First StudyAssessing the Association between EPAs, Competencies and Milestones in the Pediatric Subspecialties

• Focused on 6/7 common subspecialty EPAs

• FPD assigned level of supervision

• CCC assigned level of supervision and milestones

Academic Accomplishments• 8 abstracts presented

– APPD

– APPD LEARN PMAC

– ACGME

– PAS

• Validity of level of supervision scales accepted

to Academic Medicine

• Creation of SPIN provisionally accepted to

AMSPDC pages in J Pediatr

Academic Accomplishments• 3 additional papers in progress

– Correlation of FPD/CCC LOS ratings

– Differences in LOS ratings across the subspecialties

– Relationship between milestones and LOS ratings

for each EPA

• Over 200 collaborators

• Data from over 1000 fellows

Second StudyDetermining the Minimum Level of Supervision Required for Graduating Fellows

• Common and subspecialty-specific EPAs

– Including Scholarship EPA

• Three questions for each EPA

– Minimum level of graduation

– Need to achieve level to graduate

– At what level is a practicing physician “entrustable”

Methods• Survey of FPDs• Goal was 75% of FPDs in each subspecialty

– potential high-stakes decision– 802 ABP certified pediatric fellowships

• not a lot of programs in some subspecialties

• Subspecialty-specific LOS created

– good consistency across subs

• Survey closed early August

– 82% participation

Subspecialty Number (%)

Adolescent Medicine 23 (82)

Cardiology 47 (80)

Child Abuse 24 (83)

Critical Care 59 (88)

Developmental & Behavioral 39 (100)

Emergency Medicine 60 (78)

Endocrinology 54 (77)

Gastroenterology 54 (87)

Hematology-Oncology 58 (80)

Infectious Diseases 43 (67)

Neonatology 80 (81)

Nephrology 44 (98)

Pulmonary 46 (85)

Rheumatology 29 (81)

Survey Participation

Common EPAs

Critical Care EPAs

Dissemination

• Common EPA data through SPIN Steering Committee

• Subspecialty-specific data through individual SPIN representatives

– Guidelines developed

Third Study

Longitudinal Evaluation of the Required Level of Supervision for Pediatric Fellows• Assess fellows for 3 years

– 6 ratings

• Common and subspecialty-specific EPAs

Goals

1. Validity evidence for subspecialty-specific EPAs

2. Developmental progression of fellows

– Are they meeting minimum levels for graduation?

3. Implementation

– Are EPAs being used to guide remediation?

– What constitutes a simple versus complex case?

– How are ratings being assigned?

Goals

4. Validity evidence for scholarship EPA and relationship of LOS/milestone ratings

5. Comparison of CCC/fellow self-assessment

6. Comparison of ratings from residency to fellowship (5 common EPAs)

Methods

• Most assessments by CCC– Scholarship EPA assessment by FPD

• Fellow self-assessment• Data from LEARN database for transition to

evaluate transition from residency• FPDs will be collaborators and receive MOC

part 4 credit (if ABP approves)

Progress

• Grant submitted to ABPF

• Planned data collection December 2018

• Likely start IRB approval in next 2-3 months

Collaborators from First StudyR Abell, E Adderson, D Adkins, O Al-Ibrahim, E Alderman, C Allen, D Allen, M Amaya, R Amirnovin, J Anders, L Armsby, M Atlas, M Awonuga, F Bany-Mohammed, J Barker, C Barlow, A Barnes, G Barretto, C Barron, C Bendel, J Bhatia, B Binstadt, A Blaschke, A Blaufox, B Bokor, M Bone, K Booth, D Boyer, J Brancato, S Bratton, L Brion, M Brook, P Brophy, K Bryant, K Carlson, F Carnevale, M Carney, M Caserta, J Chapman, J Clingenpeel, D Coury, R Cron, M Currie, D Dannaway, P Dennehy, C Doughty, L Doughty, A Dozor, J El Khoury, S Etheridge, F Erenberg, C Estrada, K Fairchild, A Falck, R Fastle, M Federman, H Feldman, B Felt, G Fleming, L Frank, S Friedman, J Frohna, M Fuloria, J Fuqua, H Ganz, C Garrison, M Gillam-Krakauer, J Glickstein, B Gonzalez, B Gottleib, D Green, M Green, P Grimm, U Guillen, D Hains, M Hall, M Haller, R Harb, K Hardy, N Harik, V Havalad, V Heffner, J Helderman, M Henry, A Hergenroeder, M Hermiston, W Hoover, H Hsu, E Jacobs, J Jaroscak, L Johnston, S Johnston, T Johnston, J Journeycake, A Kale, H Karpen, R Kato, J Katz, N Kellogg, J Kiger, J Kim, O Kim, B Kinane, E Klein, S Krishnan, M Kronman, J Kugler, D Kumar, T Laskey, E Lawson, T Lee, Y Lee-Kim, M Letson, S Long, M Lowe, S Lusman, R Lutes, M Macias, L Madison, N Maraqa, K Marzan, K Mason, L Matheo, C Mauras, C McAneney, M McCabe, L McGuinn, A McQueen, J Mehta, D Meryash, K Miller, M Moffatt, Z Molle-Rios, R Mohon, R Monzavi, P Moore, K Nanda, A Narayan, E Nazarian, Y Nicolau, J Nocton, V Norwood, N Patel, J Pinheiro, J Pohl, K Potter, B Printz, R Quigley, A Rabbitt, R Rahhal, J Rama, R Ramanathan, A Rao, K Rehder, B Reinking, W Rice, Y Rivas, N Roizen, J Rose, J Rosen, M Rosenberg, C Roskind, A Ross, K Rouster-Stevens, I Sami, A Savant, S Savelli, W Sayej, A Schonwald, J Schuette, B Scottoline, J Sharma, T Sharma, E Shereck, K Simonsen, T Simpson, L Siqueira, A Sirotnak, N Slamon, L Smith, J Soprano, K Soren, T Stanley, S Starling, P Steuber, B Stryjewski, A Talati, P Teaford, M Tesher, A Thomas, K Tieves, O Titus, R Tower, M Trent, D Vanderbilt, S van Schaik, L Varlotta, M Vasquez, K Vogt, B Voigt, P Volk, P Vuguin, E Walton, A Warwick, W Waz, J Weiner, L Weiner, T Weinstein, J Welch, L Widdice, S Witchel, M Winkler, N Yeager, K Yen, C Yost, S Yussman, A Zubrow

Acknowledgements

• Alma Ramirez BS

• American Board of Pediatrics Foundation for providing financial support

• Support from pediatric subspecialty community