LAUSR

Background The ACGME Milestone Project is a competency-based assessment tool. Subcompetencies (SC) are scored on a 5-point scale, and level 4 is recommended for graduation. The 2018 Milestones Report found that across subspecialties, not all graduates are attaining a level 4 for every SC. Objective To describe the number of pediatric emergency medicine (PEM) fellows who achieve level 4 in all 23 SC at graduation and to identify SC and predictive factors where a level 4 is not achieved. Design/Methods This is a multicenter, retrospective cohort study of PEM fellows. Program directors provided de-identified milestone reports from 2015-2018. Descriptive analysis of milestone scores at graduation was performed. Demographics were compared between fellows who did and did not meet level 4 at graduation for each SC. Sub-analyses assessed differences in residency and first year milestone scores and the rate of milestone attainment between fellows who did and did not attain level 4 at graduation. Results Data from 48 PEM fellowship programs yielded graduation scores for 392 fellows (62% of total). 87% completed pediatric residency and 60% were female. Residency scores were available for 45 fellows. There were no SC in which all fellows attained at least level 4 at graduation; the range of fellows scoring Conclusion In our sample, 67% of PEM fellows did not attain level 4 for at least 1 of the 23 SC at graduation. Low scores during residency or early in fellowship may predict difficulty in meeting level 4 by fellowship completion.