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Validity Evidence From Ratings of Pediatric Interns and Subinterns on a Subset of Pediatric Milestones
Teri L Turner1, Vasudha L Bhavaraju, Ulana A Luciw-Dubas
1T.L. Turner is associate professor, Department of Pediatrics, Baylor College of Medicine, and director, Center for Research, Innovation, and Scholarship in Medical Education, Texas Children's Hospital, Houston, Texas. V.L. Bhavaraju is program director, Phoenix Children's Hospital/Maricopa Medical Center Pediatric Residency Program, Phoenix, Arizona, and clinical assistant professor, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona. U.A. Luciw-Dubas is research measurement analyst, Measurement Consulting Services, National Board of Medical Examiners, Philadelphia, Pennsylvania. P.J. Hicks is professor of clinical pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and director, Pediatrics Milestones Assessment Collaborative, Philadelphia, Pennsylvania. S. Multerer is associate professor, Department of Pediatrics, University of Louisville School of Medicine and Kosair Children's Hospital, Louisville, Kentucky. A. Osta is assistant professor of clinical pediatrics and internal medicine, and pediatrics program director, Department of Pediatrics, University of Illinois-Chicago and Children's Hospital University of Illinois, Chicago, Illinois. J. McDonnell was assistant professor of medicine, University of Illinois at Chicago, Chicago, Illinois, at the time this was written. She is now assistant professor of pediatrics, Department of Pediatrics, Rush University, Chicago, Illinois. S. Poynter is associate professor of pediatrics, Department of Pediatrics, University of Cincinnati, and codirector, pediatric residency training program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. D.J. Schumacher is assistant professor of pediatrics, Department of Pediatrics, University of Cincinnati/Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. R. Tenney-Soeiro is associate professor of clinical pediatrics, Department of Pediatrics, and codirector, pediatric clerkship, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. L. Waggoner-Fountain is program director and associate professor of pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia. A. Schwartz is Michael Reese Endowed Professor and associate head of medical education and research professor of pediatrics, University of Illinois at Chicago, Chicago, Illinois, and director, Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN), McLean, Virginia.
Purpose:
To investigate evidence for validity of faculty members' pediatric milestone (PM) ratings of interns (first-year residents) and subinterns (fourth-year medical students) on nine subcompetencies related to readiness to serve as a pediatric intern in the inpatient setting.
Method:
The Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN) and the National Board of Medical Examiners collaborated to investigate the utility of assessments of the PMs for trainees' performance. Data from 32 subinterns and 179 interns at 17 programs were collected from July 2012 through April 2013. Observers used several tools to assess learners. At each site, a faculty member used these data to make judgments about the learner's current developmental milestone in each subcompetency. Linear mixed models were fitted to milestone judgments to examine their relationship with learner's rank and subcompetency.
Results:
On a 5-point developmental scale, mean milestone levels for interns ranged from 3.20 (for the subcompetency Work effectively as a member of a team) to 3.72 (Humanism) and for subinterns from 2.89 (Organize and prioritize care) to 3.61 (Professionalization). Mean milestone ratings were significantly higher for the Professionalism competency (3.59-3.72) for all trainees compared with Patient Care (2.89-3.24) and Personal and Professional Development (3.33-3.51). Mean intern ratings were significantly higher than mean subintern ratings for all nine subcompetencies except Professionalization, Humanism, and Trustworthiness.
Conclusions:
The PMs had a coherent internal structure and could distinguish between differing levels of trainees, which supports their validation for documenting developmental progression of pediatric trainees.
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