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Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness
Su-Ting T Li1, Daniel J Tancredi, Alan Schwartz
1S.-T.T. Li is associate professor, vice chair of education, and pediatric program director, Department of Pediatrics, University of California, Davis, Sacramento, California. D.J. Tancredi is associate professor, Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, and director of research, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois. A.P. Guillot is professor, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont. A.E. Burke is professor and pediatric program director, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio. R.F. Trimm is professor, vice chair, and pediatric program director, Department of Pediatrics, University of South Alabama, Mobile, Alabama. S. Guralnick is associate professor, director of graduate medical education, and designated institutional officer, Office of Academic Affairs, Winthrop University Hospital, Mineola, New York. J.D. Mahan is professor, vice chair, and pediatric and pediatric nephrology fellowship program director, Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, Ohio. K.A. Gifford is assistant professor and pediatric program director, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Purpose:
To describe clinical skills progression during pediatric residency using the distribution of pediatric milestone assessments by subcompetency and year of training and to determine reasonable milestone expectations at time of graduation.
Method:
Multi-institutional cohort study of the milestones reported to the Accreditation Council for Graduate Medical Education for all 21 pediatric subcompetencies. Most subcompetencies were measured using five milestone levels (1 = novice, 2 = advanced beginner, 3 = competent, 4 = proficient, 5 = master); 3 subcompetencies had only four levels defined.
Results:
Milestone assessments for 2,030 pediatric residents in 47 programs during academic year 2013-2014 were obtained. There was significant variation in end-of-year milestone ratings for residents within each level of training, which decreased as training level increased. Most (78.9%; 434/550) graduating third-year pediatric residents received a milestone rating of ≥ 3 in all 21 subcompetencies; fewer (21.1%; 116/550) received a rating of ≥ 4 in all subcompetencies. Across all training levels, professionalism and interpersonal communication skills were rated highest; quality improvement was rated lowest.
Conclusions:
Trainees entered residency with a wide range of skills. As they advanced, skill variability within a training level decreased. Most graduating pediatric residents were still advancing on the milestone continuum toward proficiency and mastery, and an expectation of milestone ratings ≥ 4 in all categories upon graduation is unrealistic; milestone ratings ≥ 3 upon graduation may be more realistic. Understanding current pediatric residents' and graduates' skills can help to identify key areas that should be specifically targeted during training.
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