The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development

Hicks, Patricia J.; Schumacher, Daniel J.; Benson, Bradley J.; Burke, Ann E.; Englander, Robert; Guralnick, Susan; Ludwig, Stephan; Carraccio, Carol

doi:10.4300/jgme-d-10-00126.1

Cited by 136 publications

(73 citation statements)

References 18 publications

(20 reference statements)

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“…4,5 Thus, the milestones in their current form can stimulate discussions and reflections about physician development and competence; however, further study and adaptation will be needed before using them for high-stakes assessment and training year advancement decision-making. 6 This study will need to include validating, and adapting where necessary, the behavioral descriptions that comprise the milestone levels and establishing normative ranges for the transitions from one milestone level to another.…”

Section: Domain 2: Assessment Methods and Validationmentioning

confidence: 99%

“…3 In pediatrics, 4 to 5 developmental levels of performance, or milestones, have been developed for each of the 48 competencies within the 6 ACGME competency domains. [4][5][6][7] Through efforts to focus on a more practical number, 21 of these competencies have been selected for initial reporting purposes. 6,8 Beginning in June 2014, all pediatrics residency programs will be required to report individual resident progress on these competencies to the ACGME semiannually.…”

mentioning

confidence: 99%

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Putting the Pediatrics Milestones Into Practice: A Consensus Roadmap and Resource Analysis

et al. 2014

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The Accreditation Council for Graduate Medical Education has partnered with member boards of the American Board of Medical Specialties to initiate the next steps in advancing competency-based assessment in residency programs. This initiative, known as the Milestone Project, is a paradigm shift from traditional assessment efforts and requires all pediatrics residency programs to report individual resident progression along a series of 4 to 5 developmental levels of performance, or milestones, for individual competencies every 6 months beginning in June 2014. The effort required to successfully make this shift is tremendous given the number of training programs, training institutions, and trainees. However, it holds great promise for achieving training outcomes that align with patient needs; developing a valid, reliable, and meaningful way to track residents’ development; and providing trainees with a roadmap for learning. Recognizing the resources needed to implement this new system, the authors, all residency program leaders, provide their consensus view of the components necessary for implementing and sustaining this effort, including resource estimates for completing this work. The authors have identified 4 domains: (1) Program Review and Development of Stakeholders and Participants, (2) Assessment Methods and Validation, (3) Data and Assessment System Development, and (4) Summative Assessment and Feedback. This work can serve as a starting point and framework for collaboration with program, department, and institutional leaders to identify and garner necessary resources and plan for local and national efforts that will ensure successful transition to milestones-based assessment.

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Section: Domain 2: Assessment Methods and Validationmentioning

confidence: 99%

mentioning

confidence: 99%

Putting the Pediatrics Milestones Into Practice: A Consensus Roadmap and Resource Analysis

et al. 2014

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“…Innovation in the field currently comes through collaborative work among stakeholders in the clinical specialties to develop the educational milestones. 83,84 Competency-based education is curricular innovation. Enhancing education and evaluation adds value for learners, the health care system, and society.…”

Section: Embedding the Competencies In Resident Teaching And Evaluationmentioning

confidence: 99%

“…The EPA framework matches the competencies to ''essential activities'' of physicians, thus creating a clinical context that adds meaning for the learner and the evaluator. 84 This attribute of EPAs has the potential to bridge another gap, i.e., the discrepancy between the theory and the practice related to the competencies, and it is viewed by a growing number of educators as the new building block for the assessment of residents' acquisition of competence. 84,[89][90][91] What is largely lacking to date is research to develop and test tools and to establish their relationship to the accepted observable abstractions called the competencies and to the newer concepts of the milestones and EPAs.…”

Section: Embedding the Competencies In Resident Teaching And Evaluationmentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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“…2,3 Performance level on a subset of milestones will be reported to ACGME at 6-month intervals throughout training for each individual trainee. It is within this context that the ABP called on thought-leaders within the pediatrics community to form this task force to reassess the clinical component of fellowship training.…”

mentioning

confidence: 99%

The Initiative on Subspecialty Clinical Training and Certification (SCTC): Background and Recommendations

Stevenson

McGuinness²,

Bancroft

et al. 2014

Pediatrics

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The American Board of Pediatrics (ABP) certifies general pediatricians and pediatric subspecialists based on standards of excellence that lead to high-quality health care during infancy, childhood, adolescence, and the transition into adulthood. Thus, central to the ABP' s mission is assurance to the public that a general pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills the continuous evaluation requirements that encompass the 6 core competencies of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). The ABP' s quest for excellence is evident in its rigorous evaluation process and in new initiatives undertaken that not only continually improve the standards of its certification but also advance the science, education, study, and practice of pediatrics.The ABP' s responsibilities and authorities in standard setting and evaluation overlap through interest and influence the responsibilities and authorities assumed by the ACGME through its Pediatric Review Committee in the area of training, as well as those of the American Academy of Pediatrics and the subspecialty societies with respect to advocacy and education. Although the respective organizations have distinct missions and roles, they often work in collaboration and synergy regarding training and advocacy. Nonetheless, standard setting, evaluation, and certification remain the sole purview of the ABP. Because of the centrality of accredited training to certification, a decision by the ABP to offer a subspecialty certificate leads to a petition to the ACGME to accredit training programs. The ABP provides substantial input to the development of initial subspecialty program requirements and periodic revisions through its respective subboards, and the ABP standards for certification heavily influence the content of program requirements. COMPETENCY-BASED MEDICAL EDUCATIONIn the late 1990s, the ACGME and ABMS introduced the concept of competency-based medical education (CBME) with the establishment of 6 domains of competence: patient care, medical knowledge, practicebased learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. 1 Although the domains of competence have been widely adopted across medical education, the ability to measure a learner' s performance of the skills related to the competencies has emerged as a major limiting factor to realizing the full potential of CBME. To address this issue, the ACGME partnered with the member boards of ABMS in the Milestones Project. In

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The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development

Cited by 136 publications

References 18 publications

Putting the Pediatrics Milestones Into Practice: A Consensus Roadmap and Resource Analysis

Putting the Pediatrics Milestones Into Practice: A Consensus Roadmap and Resource Analysis

Review article: Closing the research gap at the interface of learning and clinical practice

The Initiative on Subspecialty Clinical Training and Certification (SCTC): Background and Recommendations

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