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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.

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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.