Milestones comparisons from residency to pediatric emergency medicine fellowship: Resetting expectations

Abstract

Background: Pediatric emergency medicine (PEM) fellowships accept trainees who have completed a residency in either emergency medicine (EM) or pediatrics and have adopted 17 subcompetencies with accompanying set of milestones from these two residency programs. This study aims to examine the changes in milestone scores among common subcompetencies from the end of EM or pediatrics residency to early PEM fellowship and evaluates time to reattainment of scores for subcompetencies in which a decline was noted. Methods: This is a national, retrospective cohort study of trainees enrolled in PEM fellowship programs from July 2014 to June 2018. PEM fellowship program directors voluntarily submitted deidentified milestone reports within the study time frame, including end-of-residency reports. Descriptive analyses of milestone scores between end of residency and PEM fellowship were performed. Results: Forty-eight U.S. PEM fellowship programs (65%) provided fellowship milestone data on 638 fellows, 218 (34%) of whom also had end-of-residency milestone scores submitted. Of 218 fellows eligible for analysis, 210 (96%) had completed a pediatrics residency and eight (4%) had completed an EM residency. Pediatric-trained fellows had statistically significant decreases in mean milestone scores in all 10 shared subcompetencies. Reattainment of milestone scores across all common subcompetencies for both EM and pediatric-trained PEM fellows occurred by the end of fellowship. Conclusions: This study demonstrated declines in milestone scores from the end of primary residency training in pediatrics to early PEM fellowship in shared subcompetencies, which may suggest that performance expectations are reset at the beginning of PEM fellowship. Changes in subcompetency milestone anchors to provide subspecialty-specific context may be needed to more accurately define skills acquisition in the residency-to-fellowship transition. How to cite this article: Vu TT, Rose JA, Shabanova V, et al. Milestones comparisons from residency to pediatric emergency medicine fellowship: Resetting expectations. AEM

Are Final Residency Milestones Correlated With Early Fellowship Performance in Pediatrics?

“…Our study included 726 neonatal–perinatal medicine trainees during a 4-year period, and our data demonstrated similar findings, with an approximate 1.2-point decrease in milestones scored from the end of residency to early fellowship. Our findings are consistent with these 2 smaller studies 23,24 and support the notion that performance on milestones resets at the beginning of fellowship and that even scores for shared milestones are dependent on clinical and/or academic context.…”

What to know about 2.0: Revisions to the pediatric emergency medicine milestones

“…A summary of the subcompetency‐specific additions, deletions, and updates to individual milestones is provided in Tables 2–4. While training programs have variably interpreted PEM Milestones 1.0, there was a general tendency to rate early PEM fellows lower in shared subcompetencies than they were upon graduating residency and to interpret Level 5 as a graduating fellow, rather than aspirational 6,7 . As a result, the working group deliberately worded narrative anchors to align with the Dreyfus model, ensuring that Level 1 matched expectations for a PGY‐4 and that Level 5 remained aspirational.…”

“…Educators also lamented difficulties in sharing assessment tools across programs and disciplines 1,5 . The PEM milestones have additionally been criticized for a lack of expected continuity transitioning from residency to fellowship 6–8 …”

“…1,5 The PEM milestones have additionally been criticized for a lack of expected continuity transitioning from residency to fellowship. [6][7][8] The ACGME's review process was followed by iterative stages of community engagement to refine specialty-specific milestones.…”

Attitudes and training related to substance use in pediatric emergency departments

“…PEM physician’s training is unique among the pediatric subspecialities, in that physician can enroll in a fellowship after completing a residency in either pediatrics or emergency medicine, with the majority being pediatric trained. The overall number of EM-trained PEM physicians is low and continues to decline [ 24 ]. An important gap in pediatric training may be the lack of routine education on substance use and substance use disorders in PEM curricula as compared to adult EM education, as well as physician comfort in treating substance use and related harms.…”