Accreditation Council for Graduate Medical Education Milestone Scores in Pediatrics: Pilot Study Exploring the Relationship Between Residency and Early Fellowship Scores

BACKGROUND: The Accreditation Council for Graduate Medi-cal Education requires Milestone-based assessments of residents and fellows. In pediatrics, 11 subcompetencies are common to both residency and subspecialty fellowship training. It is unknown whether Milestone scores achieved during residency are related to Milestone scores achieved in early fellowship.OBJECTIVE: To assess the relationship between final residency Milestones scores and first-year fellowship Milestones scores in the 11 common subcompetencies (CSCs) across pediatric subspecialties. METHODS: This was a retrospective single-institution cohort study of pediatric fellows beginning fellowship training between July 2016 and July 2019. De-identified Milestone score sets for final residency scores (R), mid-year first-year fel-lowship scores (F1), and final first-year fellowship scores (F2) were collected. Spearman correlation and regression analyses were used to assess score relationships. RESULTS: Data for 85 of 98 eligible fellows were collected. Consistently, the F1 scores were lowest, and the R scores were highest. There was a weak positive correlation between the composite R scores and the composite F1 scores. There was a weak positive correlation between residency and fellowship scores for 6 CSCs and no significant correlation for the remain-ing 5. CONCLUSION: For the 11 pediatric CSCs, the final residency Milestone scores are consistently higher than and only weakly associated with early fellowship Milestone scores. There may be limitations to the use of residency scores for fellowship pro-gram directors in guiding individualized education for early fellows. This study provides groundwork for additional study of Milestone relationships and may help inform the next itera-tion of pediatric subspecialty Milestones.