Putting the Pediatrics Milestones Into Practice: A Consensus Roadmap and Resource Analysis

Abstract

The Accreditation Council for Graduate Medical Education has partnered with member boards of the American Board of Medical Specialties to initiate the next steps in advancing competency-based assessment in residency programs. This initiative, known as the Milestone Project, is a paradigm shift from traditional assessment efforts and requires all pediatrics residency programs to report individual resident progression along a series of 4 to 5 developmental levels of performance, or milestones, for individual competencies every 6 months beginning in June 2014. The effort required to successfully make this shift is tremendous given the number of training programs, training institutions, and trainees. However, it holds great promise for achieving training outcomes that align with patient needs; developing a valid, reliable, and meaningful way to track residents’ development; and providing trainees with a roadmap for learning. Recognizing the resources needed to implement this new system, the authors, all residency program leaders, provide their consensus view of the components necessary for implementing and sustaining this effort, including resource estimates for completing this work. The authors have identified 4 domains: (1) Program Review and Development of Stakeholders and Participants, (2) Assessment Methods and Validation, (3) Data and Assessment System Development, and (4) Summative Assessment and Feedback. This work can serve as a starting point and framework for collaboration with program, department, and institutional leaders to identify and garner necessary resources and plan for local and national efforts that will ensure successful transition to milestones-based assessment.

Pediatric Resident Workload Intensity and Variability

“…The ACGME Pediatrics Milestone Project, implemented in 2014, was a significant step toward the creation of valid, standardized educational goals and the achievement thereof. 22 The availability of an objective workload report, as described in our data, could supplement the Milestone Project by offering a reproducible, quantifiable, and impartial means of assessing resident activities. For example, one of the ACGME Pediatrics Milestones within the Patient Care section is, "Organize and prioritize responsibilities to provide patient care that is safe, effective, and efficient."…”

Milestone-Based Assessments Are Superior to Likert-Type Assessments in Illustrating Trainee Progression

“…5,6 As noted by Schumacher et al, 7 ''in the absence of nationally developed assessment tools with sufficient validity and reliability, individual programs must . .…”

Marking the Path Forward With Milestones

“…The American Board of Pediatrics will work with others to advance that objective. We support the other proposed solutions, 1 namely handheld devices at the point of care, relational database support of a residency management system that synthesizes information from an array of tools, and the ability of this system to generate formative reports for learners as well as evidence of learner and program progress for institutions and regulatory bodies.…”

“…Schumacher et al 1 have advanced resident education by articulating the extensive resources necessary to fully implement the Pediatrics Milestones. The old assessment system is inadequate.…”