The pediatrics milestones: conceptual framework, guiding principles, and approach to development

Area of Science:

• Medical Education
• Pediatric Training
• Competency-Based Education

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Pediatrics (ABP) initiated the Pediatrics Milestone Project.
• The project refines the 6 ACGME competencies and establishes performance standards for pediatric residency programs.
• This initiative supports the documentation of training outcomes and program effectiveness.

Purpose of the Study:

• To develop a developmental framework for assessing pediatric resident performance.
• To create narrative descriptions of behaviors reflecting the continuum of learning and practice.
• To establish a foundation for meaningful outcome assessment in pediatric education.

Main Methods:

• A working group systematically searched the medical literature and other sources.
• Developed 52 subcompetencies with a focus on developmental progression.
• Created and iteratively refined milestone descriptions based on evidence and consensus.

Main Results:

• Completed the first iteration of milestones for all 52 subcompetencies.
• Milestones include narrative descriptions of behaviors demonstrating knowledge, skill, and attitude development.
• Each milestone is supported by literature synopses, references, and conceptual frameworks.

Conclusions:

• The developed pediatrics milestones represent a significant step toward effective outcome assessment.
• Future work includes rigorous study, modification, and the establishment of performance standards.
• The ultimate goal is to aid program directors in making reliable judgments about resident competence and program success.