Sawyer Taylor, Gray Megan, Chabra Shilpi, Johnston Lindsay C, Carbajal Melissa M, Gillam-Krakauer Maria, Brady Jennifer M, French Heather
is Associate Fellowship Director, Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine.
is Fellowship Director, Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine.
J Grad Med Educ. 2021 Jun;13(3):377-384. doi: 10.4300/JGME-D-20-00954.1. Epub 2021 Jun 14.
A vital element of the Next Accreditation System is measuring and reporting educational Milestones. Little is known about changes in Milestones levels during the transition from residency to fellowship training.
Evaluate the Accreditation Council for Graduate Medical Education (ACGME) Milestones' ability to provide a linear trajectory of professional development from general pediatrics residency to neonatal-perinatal medicine (NPM) fellowship training.
We identified 11 subcompetencies that were the same for general pediatrics residency and NPM fellowship. We then extracted the last residency Milestone level and the first fellowship Milestone level for each subcompetency from the ACGME's Accreditation Data System on 89 subjects who started fellowship training between 2014 and 2018 at 6 NPM fellowship programs. Mixed-effects models were used to examine the intra-individual changes in Milestone scores between residency and fellowship after adjusting for the effects of the individual programs.
A total of 1905 subcompetency Milestone levels were analyzed. The average first fellowship Milestone levels were significantly lower than the last residency Milestone levels (residency, mean 3.99 [SD = 0.48] vs fellowship 2.51 [SD = 0.56]; < .001). Milestone levels decreased by an average of -1.49 (SD = 0.65) from the last residency to the first fellowship evaluation. Significant differences in Milestone levels were seen in both context-dependent subcompetencies (patient care and medical knowledge) and context-independent subcompetencies (professionalism).
Contrary to providing a linear trajectory of professional development, we found that Milestone levels were reset when trainees transitioned from general pediatrics residency to NPM fellowship.
下一代认证系统的一个关键要素是衡量和报告教育里程碑。对于从住院医师培训过渡到专科 fellowship 培训期间里程碑水平的变化，我们了解甚少。
评估毕业后医学教育认证委员会（ACGME）的里程碑在提供从普通儿科学住院医师培训到新生儿 - 围产医学（NPM）专科 fellowship 培训的专业发展线性轨迹方面的能力。
我们确定了 11 项普通儿科学住院医师培训和 NPM 专科 fellowship 相同的亚能力。然后从 ACGME 的认证数据系统中提取了 2014 年至 2018 年期间在 6 个 NPM 专科 fellowship 项目开始专科 fellowship 培训的 89 名受试者的每个亚能力的最后住院医师里程碑水平和第一个专科 fellowship 里程碑水平。在调整了各个项目的影响后，使用混合效应模型来检查住院医师培训和专科 fellowship 之间里程碑分数的个体内变化。
共分析了 1905 个亚能力里程碑水平。第一个专科 fellowship 里程碑的平均水平显著低于最后住院医师里程碑水平（住院医师，平均 3.99 [标准差 = 0.48] 对专科 fellowship 2.51 [标准差 = 0.56]；<0.001）。从最后住院医师评估到第一个专科 fellowship评估，里程碑水平平均下降了 -1.49（标准差 = 0.65）。在依赖情境的亚能力（患者护理和医学知识）和不依赖情境的亚能力（职业素养）中，里程碑水平均存在显著差异。
与提供专业发展的线性轨迹相反，我们发现当学员从普通儿科学住院医师培训过渡到 NPM 专科 fellowship 时，里程碑水平被重置。
