Milestone Level Changes From Residency to Fellowship: A Multicenter Cohort Study

Abstract

Background A vital element of the Next Accreditation System is measuring and reporting educational Milestones. Little is known about changes in Milestones levels during the transition from residency to fellowship training. Objective Evaluate the Accreditation Council for Graduate Medical Education (ACGME) Milestones' ability to provide a linear trajectory of professional development from general pediatrics residency to neonatal-perinatal medicine (NPM) fellowship training. Methods We identified 11 subcompetencies that were the same for general pediatrics residency and NPM fellowship. We then extracted the last residency Milestone level and the first fellowship Milestone level for each subcompetency from the ACGME's Accreditation Data System on 89 subjects who started fellowship training between 2014 and 2018 at 6 NPM fellowship programs. Mixed-effects models were used to examine the intra-individual changes in Milestone scores between residency and fellowship after adjusting for the effects of the individual programs. Results A total of 1905 subcompetency Milestone levels were analyzed. The average first fellowship Milestone levels were significantly lower than the last residency Milestone levels (residency, mean 3.99 [SD = 0.48] vs fellowship 2.51 [SD = 0.56]; P < .001). Milestone levels decreased by an average of -1.49 (SD = 0.65) from the last residency to the first fellowship evaluation. Significant differences in Milestone levels were seen in both context-dependent subcompetencies (patient care and medical knowledge) and context-independent subcompetencies (professionalism). Conclusions Contrary to providing a linear trajectory of professional development, we found that Milestone levels were reset when trainees transitioned from general pediatrics residency to NPM fellowship.

Are Final Residency Milestones Correlated With Early Fellowship Performance in Pediatrics?

“…Our study included 726 neonatal–perinatal medicine trainees during a 4-year period, and our data demonstrated similar findings, with an approximate 1.2-point decrease in milestones scored from the end of residency to early fellowship. Our findings are consistent with these 2 smaller studies 23,24 and support the notion that performance on milestones resets at the beginning of fellowship and that even scores for shared milestones are dependent on clinical and/or academic context.…”

“…These findings are consistent with our finding (both explicitly in PEM fellowships and in other pediatric subspecialty fellowships) that there is a decrease in milestone scores from the end of residency to early fellowship in the group of shared milestones. A study by Sawyer et al 24 of 89 neonatal–perinatal medicine fellows during a 2-year period found that the mean F1 and F2 scores were significantly lower than the R scores, decreasing by a mean of approximately 1.5 points from the end of residency. Our study included 726 neonatal–perinatal medicine trainees during a 4-year period, and our data demonstrated similar findings, with an approximate 1.2-point decrease in milestones scored from the end of residency to early fellowship.…”

The transition to Pediatric Hospital Medicine fellowship: A national survey‐based needs assessment

“…Chief residency can provide key skill-building time for residents, but data are varied around how these skills translate to pediatric fellowship. [25][26][27] Our findings suggest that both chief residency and gap year experiences may be valuable for the transition to PHM fellowship. As PHM remains one of the most competitive pediatric specialties in the NRMP Match, future work to explore this finding could help both residency programs to mentor residents interested in PHM and fellowship programs to select applicants during recruitment.…”

“…Almost half of the fellows in our study participated in chief residency and/or gap year experiences before PHM fellowship. Chief residency can provide key skill‐building time for residents, but data are varied around how these skills translate to pediatric fellowship 25–27 . Our findings suggest that both chief residency and gap year experiences may be valuable for the transition to PHM fellowship.…”

The Transition From Residency to Fellowship: Enhancing Training by Increasing Transparency

“…Further complicating the frequent lack in fellowship applications of detailed, objective, and actionable data on resident performance is the fact that resident evaluation over the final year is not disclosed to fellowship programs. Studies suggest that milestone ratings in residency correlate with milestone ratings in fellowship ( 8 ), but that milestone ratings may go down from the end of residency to the beginning of fellowship ( 9 ). Therefore, a mechanism that allows residency programs to provide fellowship programs with data on resident performance over the final year would help facilitate the assessment of fellows and address the differences in ratings with trainees, thus furthering mutual understanding and buy‐in.…”