Defining Practice Ready: Ensuring Training and Certification Are Designed to Meet Patient Needs

Graduate medical education is grounded in a core commitment to the public: that individuals who complete a training program and are certified by their specialty board are "practice ready"-that is, they are able to meet the needs of their patients (and caregivers) upon entering practice. Beginning in 2028, the American Board of Pediatrics (ABP) aims to advance and operationalize this commitment by requiring program directors to attest that graduates are able to perform the essential activities of their discipline, as defined by the Entrustable Professional Activities (EPAs), to qualify for initial certification. To ensure that decisions about both graduation and certification eligibility are based on whether the new physician can meet the needs of their patients in real-world practice, we must clarify not only what graduates must do (the EPAs) but also how well and under what conditions and contexts they must perform them. This article provides that clarity: A "practice ready" trainee can provide safe and effective care without assigned supervision in the context of a posttraining collaborative practice environment in the discipline in which they have been trained. We unpack this definition and clarify key concepts, such as the importance of help-seeking and collaboration over independence, by introducing and applying a supervision scale to illustrative case examples. We conclude by outlining next steps for programs and future directions for the pediatric community and ABP, situating this foundational work within the broader implementation efforts required to ensure new pediatricians entering practice can meet their patients' needs.