56. PROGRAM DIRECTOR MINIMUM MILESTONE EXPECTATIONS OF PEDIATRIC RESIDENTS BEFORE READY TO SUPERVISE OTHERS AND BEFORE GRADUATION

BackgroundIn 2013, the Accreditation Council for Graduate Medical Education (ACGME) began requiring program directors (PDs) to report Milestone levels for every resident semiannually. Our prior 2015 survey found that few PDs had minimum Milestone level expectations before residents are ready to supervise (20%) or ready to graduate (20%).ObjectiveCharacterize present day model for pediatric PD minimum Milestone expectations for residents before being ready to supervise and graduate.MethodsCross-sectional survey in Spring 2018 of pediatric PDs on their program Milestone expectations before residents are ready to supervise and graduate. At programs with no established Milestone expectations, PDs indicated expectations they considered for use in their program. Descriptive analyses were used to explore PD minimum expectations by level of training.ResultsResponse rate was 46.2% (93/201). Few programs have minimum Milestone levels before residents are ready to supervise (22.6%; 21/93) or graduate (36.6%; 34/93). Minimum expectations before a resident was ready to supervise were highest for trustworthiness (Prof5), professional conduct (Prof3), professionalization (Prof2), transfer of care (PC3), organize and prioritize (PC2), humanism (Prof1), and help-seeking (Prof4), where most PDs felt that Level 2.5 was the minimum expectation. PD expectations for supervising residents were lowest for learning activities (PBLI2) and advocacy (SBP2), where the majority of PDs felt that there was no minimum or that Level 1 was sufficient. Minimum expectations for graduates were highest for diagnostic/therapeutic decisions (PC4), develop management plans (PC5), gather information (PC1), organize and prioritize (PC2), professionalization (Prof2), and trustworthiness (Prof5), where >70% of PDs felt that Level 3.0 was the minimum (Figure). PD expectations for graduating residents were lowest for quality improvement (PBLI3), advocacy, learning activities, and evidence-based medicine (MK), where >40% of PDs felt that Level 2.5 was the minimum.ConclusionsFive years after the ACGME required Milestone reporting, only a minority of PDs have established minimum Milestones before residents are ready to supervise or ready to graduate. However, more PDs have minimum Milestone levels before residents are ready to graduate than in 2015 (36.6% vs 20%) and PDs recognize the relative importance of different competencies in establishing readiness to supervise and readiness to graduate. In 2013, the Accreditation Council for Graduate Medical Education (ACGME) began requiring program directors (PDs) to report Milestone levels for every resident semiannually. Our prior 2015 survey found that few PDs had minimum Milestone level expectations before residents are ready to supervise (20%) or ready to graduate (20%). Characterize present day model for pediatric PD minimum Milestone expectations for residents before being ready to supervise and graduate. Cross-sectional survey in Spring 2018 of pediatric PDs on their program Milestone expectations before residents are ready to supervise and graduate. At programs with no established Milestone expectations, PDs indicated expectations they considered for use in their program. Descriptive analyses were used to explore PD minimum expectations by level of training. Response rate was 46.2% (93/201). Few programs have minimum Milestone levels before residents are ready to supervise (22.6%; 21/93) or graduate (36.6%; 34/93). Minimum expectations before a resident was ready to supervise were highest for trustworthiness (Prof5), professional conduct (Prof3), professionalization (Prof2), transfer of care (PC3), organize and prioritize (PC2), humanism (Prof1), and help-seeking (Prof4), where most PDs felt that Level 2.5 was the minimum expectation. PD expectations for supervising residents were lowest for learning activities (PBLI2) and advocacy (SBP2), where the majority of PDs felt that there was no minimum or that Level 1 was sufficient. Minimum expectations for graduates were highest for diagnostic/therapeutic decisions (PC4), develop management plans (PC5), gather information (PC1), organize and prioritize (PC2), professionalization (Prof2), and trustworthiness (Prof5), where >70% of PDs felt that Level 3.0 was the minimum (Figure). PD expectations for graduating residents were lowest for quality improvement (PBLI3), advocacy, learning activities, and evidence-based medicine (MK), where >40% of PDs felt that Level 2.5 was the minimum. Five years after the ACGME required Milestone reporting, only a minority of PDs have established minimum Milestones before residents are ready to supervise or ready to graduate. However, more PDs have minimum Milestone levels before residents are ready to graduate than in 2015 (36.6% vs 20%) and PDs recognize the relative importance of different competencies in establishing readiness to supervise and readiness to graduate.