Pediatric emergency medicine fellows' milestone evaluations: Do they all meet the targets for graduation?

Abstract

The ACGME Milestone Project created a competency-based trainee assessment tool. Subcompetencies (SCs) are scored on a 5-point scale; level 4 is recommended for graduation. The 2018Milestones Report found that across subspecialties, not all graduates attain level 4 for every SC. The objective was to describe the number of pediatric emergency medicine (PEM) fellows who achieve ≥ level 4 in all 23 SCs at graduation and identify SCs where level 4 is not achieved and factors predictive of not achieving a level 4. This is a multicenter, retrospective cohort study of PEM fellows from 2014 to 2018. Program directors provided milestone reports. Descriptive analysis of SC scores wasperformed.Subanalysesassesseddifferences inresidency graduation scores, first-yearfellowship scores,andthe rate of milestone attainment between fellows whodidanddid not attain≥ level 4 at graduation. Data from 392 fellows were obtained. There were noSCsin which all fellows attained≥ level 4 at graduation; the range of fellowsscoring<level4perSCwas 7% to 39%.A total of 67%offellowsdid notattain≥ level 4 onone or more SC.While some fellows failed to attain ≥ level 4 on up toall23SCs,26% failed to meetlevel 4 on only one or two.In 19 SCs, residency graduation and/or first year fellow scores were lower for fellows who did not attain ≥ level 4 at graduation compared to those who did (mean difference= 0.74 points).Among 10 SCs, fellows who did not attain≥ level 4 at graduation had a faster rate ofimprovement compared to those who did attain ≥ level 4. Inour sample,67%ofPEM fellows did not attainlevel 4forone or more of theSCsat graduation.Low scoresduringresidency orearly infellowship may predict difficulty in meetinglevel 4 byfellowship completion.