Ushering in a New Era of Training in Child Neurology Using Competency-Based Education: Kathryn Xixis, MD

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"When we do interventions like [entrustable professional activities], where we are giving feedback in the moment, not 6 months later, not at the end of the rotation, there is evidence that people do change their behaviors and improve their outcomes by getting that level of feedback."

Medical education has increasingly shifted in recent decades toward a competency-based medical education (CBME) framework, which is an outcomes-focused model that emphasizes formative, workplace-based assessments rather than relying solely on traditional summative evaluations.¹ Moreover, entrustable professional activities (EPAs) were developed as discrete units of professional work to provide context for competencies and offer evaluators a structured method for assessing specific clinical tasks. Initially used primarily in post graduate training, EPAs are now also being applied in undergraduate medical education

The development of standardized EPAs and their integration into medical schools aims to clarify the competencies expected of graduates and reduce variability in trainee skills. This approach can guide curricular planning to support students in acquiring essential competencies prior to post graduate training. When students do not meet certain benchmarks, additional learning opportunities may be provided to help them achieve the expected level of competence. Child neurologist Kathryn Xixis, MD, recently presented a session focused on developing EPAs specifically for child neurology training at the 54th Child Neurology Society (CNS) Annual Meeting, held October 8-11, 2025, in Charlotte, North Carolina.

In an interview at the meeting with Contemporary Pediatrics, our sister publication, Xixis, an associate professor of neurology and pediatrics at the University of Virginia, emphasized the growing transition in medical training toward CBME, which focuses on outcomes rather than time spent on training. She highlighted the role of EPAs as structured methods for assessing competence through real-time, formative feedback. During the conversation, Xixis noted that although child neurology is still catching up to other specialties in implementing EPAs, evidence supports their efficacy in improving trainee performance and patient care. Additionally, she underscored the importance of ensuring that all graduates meet established competency standards.

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REFERENCES
1. Kuehl SE, Spicer JO. Using entrustable professional activities to better prepare students for their postgraduate medical training: A medical student's perspective. Perspect Med Educ. 2022;11(6):359-364. doi:10.1007/s40037-022-00731-x
2. Xixis K. Defining the Outcome: Developing EPAs for Child Neurology Training. Presented at: 2025 Child Neurology Society Annual Meeting. October 8-11; Charlotte, North Carolina. Child Neurology/NDD Educators Symposium: Teach, Mentor, and Inspire: A Symposium for the Child Neurology Educator.