The Next Phase of Pediatric Residency Education: The Partnership of the Milestones Project

Abstract

concerns of patient safety, policymakers and the public are demanding a response. The American Board of Pediatrics, the Accreditation Council of Graduate Medical Education (ACGME), the Association of Pediatric Program Directors (APPD), and other organizations are working together to position pediatrics to meet these demands and keep the public trust for excellence in the care of children. Program directors and educators recognize that there are many barriers to medical education reform, including but not limited to lack of resources; traditional training of physicians, which lacks a focus on curricular design and learner and program assessment; and a foundation in conducting educational research. 2 However, the public and government stakeholders expect safe and effective care documented by patient outcome data, 3 ongoing participation in quality improvement activities, and assurances of adequate supervision for trainees. Recent health care reform bills contain specific language that speaks to ‘‘demonstration of outcomes in medical education.’’ 3 Upon graduation, patients and families want assurance that both new generalist and specialist pediatricians have become skilled in all aspects of the 6 ACGME competencies 4 (Table 1), which translates into a physician who provides patient-centered care, applies best evidence, functions effectively in multidisciplinary teams to coordinate care, and advocates for their patient needs by helping them navigate the complexities of the health care system. Moreover, as the hours and structure of training change, we are obligated to demonstrate that future graduates are prepared to enter practice without direct supervision. We must have a sense of urgency to address these expectations or we will face additional external oversight beyond our own programs, institutions, and current accreditation organizations. The Milestones Project provides a way for us, as a self-regulating profession, to uphold the public trust. The ACGME, in partnership with the American Board of Pediatrics, has initiated the Milestones Project as the next step in moving toward an outcomes-based measurement of training, evolving beyond more basic structure and process measures. 5–7 The plan is to partner with each member board within the American Board of Medical Specialties to spearhead the development of a grassroots effort to further define the ACGME competencies within the context of their specialty. Pediatrics is 1 of the first 3 disciplines, along with internal medicine and surgery, to construct Milestones as outcome measures of the competencies.