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Reported Pediatrics Milestones (Mostly) Measure Program, Not Learner Performance
Kimberly Hu1, Patricia J Hicks2, Melissa Margolis3
1K. Hu is an MD/MPH student, University of Illinois at Chicago, Chicago, Illinois.
Summary
Pediatrics Milestones Assessment Collaborative (PMAC) scores show more learner variance than ACGME milestones, which have substantial program variance. Comparing intern milestones across programs without adjustment is problematic.
Area of Science:
- Medical Education
- Graduate Medical Training
- Pediatric Residency
Background:
- U.S. pediatrics residency programs report resident milestone levels to the Accreditation Council for Graduate Medical Education (ACGME) semiannually.
- The Pediatrics Milestones Assessment Collaborative (PMAC) developed workplace-based assessments for intern readiness (D1) and readiness for independent inpatient care (D2).
Purpose of the Study:
- To compare learner and program variance in PMAC scores versus ACGME milestones.
- To analyze sources of variance in PMAC scores and milestones.
Main Methods:
- Examined data from 181 interns across 8 U.S. pediatrics residency programs (November 2015 - May 2017).
- Utilized random effects models incorporating program, competency, learner, and program × competency components.
Main Results:
- Program variance was substantial for milestones (54% D1, 68% D2) but not PMAC scores (12% D1, 10% D2).
- Learner variance was higher in PMAC scores (44% D1, 26% D2) compared to milestones (22% D1, 14% D2).
- PMAC scores correlated positively with milestones within programs.
Conclusions:
- PMAC assessments exhibit less program-specific variance and are more sensitive to within-program learner differences than milestones.
- Milestones indicate greater program-based differences, potentially reflecting performance variations or reporting scale usage.
- Direct comparison of individual learner milestones across programs without accounting for program effects is ill-advised.
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