Pediatric Endocrinology Milestones 2.0—guide to their implementation

The Milestones were initiated by the Accreditation Council for Graduate Medical Education (ACGME) to provide a framework for monitoring a trainee’s progression throughout residency/fellowship. The Milestones describe stepwise skill progression through six core domains of clinical competency: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice. Since their introduction in 2013, several barriers to implementation have emerged. Thus, the ACGME launched the Milestones 2.0 project to develop updated specialty-specific milestones. The Pediatric Endocrinology Milestones 2.0 project aimed to improve upon Milestones 1.0 by addressing common limitations, providing resources for faculty to easily incorporate milestones into their assessment of trainees, and adding sub-competencies in health disparities, patient safety, and physician well-being. This paper reviews the development of the Pediatric Endocrinology Milestones 2.0 including the major changes from Milestones 1.0, development of the Supplemental Guide, and how Milestones 2.0 can be applied at the program level. Although use of the Milestones are required only for ACGME programs, the tools provided in Milestones 2.0 are applicable to fellowship programs worldwide. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-023-04862-5.

Examples are provided for some milestones within this document.Please note: the examples are not the required element or outcome; they are provided as a way to share the intent of the element.
A Supplemental Guide is also available to provide the intent of each subcompetency, examples for each level, assessment methods or tools, and other available resources.The Supplemental Guide, like examples contained within the Milestones, is designed only to assist the program director and Clinical Competency Committee, and is not meant to demonstrate any required element or outcome.
Additional resources are available in the Milestones section of the ACGME website.Follow the links under "What We Do" at www.acgme.org.
©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes. vi The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet.For each reporting period, a fellow's performance on the milestones for each sub-competency will be indicated by selecting the level of milestones that best describes that fellow's performance in relation to those milestones.
Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated.
Selecting a response box on the line in between levels indicates that milestones in lower levels have been substantially demonstrated as well as some milestones in the higher level(s).

Comments:
This subcompetency is not intended to evaluate a fellow's well-being, but to ensure each fellow has the fundamental knowledge of factors that impact wellbeing, the mechanisms by which those factors impact well-being, and available resources and tools to improve well-being.

Patient Care 4: Diagnostic Testing, Including Labs, Imaging, and Functional Testing
Pediatric Endocrinology, ACGME Report Worksheet ©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.1All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.4 ©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.2©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.3©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.6Medical Knowledge 1: Physiology and Pathophysiology ©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.7Medical Knowledge 2: Clinical Reasoning ©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.8Medical Knowledge 3: Therapeutics (Behavioral, Medications, Technology, Radiopharmaceuticals) ©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.9©2022 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Pediatric Endocrinology Milestones on a non-exclusive basis for educational purposes.10Systems-

Based Practice 2: Quality Improvement
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Based Practice 3: System Navigation for Patient Centered Care -Coordination of Care
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Based Practice 4: System Navigation for Patient-Centered Care -Transitions in Care
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Based Practice 5: Population and Community Health
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Based Practice 6: Physician Role in Health Care Systems
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Based Learning and Improvement 1: Evidence-Based and Informed Practice
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Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Growth
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21 Interpersonal and Communication Skills 1: Patient-and Family-Centered Communication
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22 Interpersonal and Communication Skills 2: Patient and Family Education
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23 Interpersonal and Communication Skills 3: Interprofessional and Team Communication
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