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Part 5: Essentials of Neonatal-Perinatal Medicine Fellowship: evaluation of competence and proficiency using Milestones

Journal of Perinatology volume 42, pages 809–814 (2022)Cite this article

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Abstract

The Accreditation Council for Graduate Medical Education (ACGME) Pediatric Subspecialty Milestone Project competencies are used for Neonatal-Perinatal Medicine (NPM) fellows. Milestones are longitudinal markers that range from novice to expert (levels 1–5). There is no standard approach to the required biannual evaluation of fellows by fellowship programs, resulting in significant variability among programs regarding procedural experience and exposure to pathology during clinical training. In this paper, we discuss the opportunities that Milestones provide, potential strategies to address challenges, and future directions.

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Fig. 1: National Milestone Data for Benchmarking Fellow Performance.

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References

  1. Warm EJ, Edgar L, Kelleher M, Kinnear B, Sall D, Luciano G, et al. Accreditation council for graduate medical education: a guidebook for implementing and changing assessment in the milestones area. ACGME; 2020. https://www.acgme.org/globalassets/milestones-implementation-2020.pdf.

  2. Hicks PJ, Englander R, Schumacher DJ, Burke A, Benson BJ, Guralnick S, et al. Pediatrics milestone project: next steps toward meaningful outcomes assessment. J Grad Med Educ. 2010;2:577–84.

    Article  Google Scholar 

  3. Swing S. The Pediatrics Subspecialty Milestone Project. The Accreditation Council for Graduate Medical Education and: ACGME; 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/PediatricsSubspecialtyMilestones.pdf.

  4. Hamstra SJ, Yamazaki K, Shah H, Kondur S, Edgar L, Sangha S, et al. ACGME Milestones National Report 2019 Executive Summary. 2019. https://www.acgme.org/Portals/0/PDFs/Milestones/2019MilestonesNationalReportFinal.pdf?ver=2019-09-30-110837-587.%20Accessed%207/16/2020.

  5. Miller A, Archer J. Impact of workplace based assessment on doctors’ education and performance: a systematic review. BMJ. 2010;341:c5064.

    Article  Google Scholar 

  6. Natesan S, Stehman C, Shaw R, Story D, Krzyzaniak SM, Gottlieb M. Curated collections for educators: five key papers about receiving feedback in medical education. Cureus. 2019;11:e5728.

    PubMed  PubMed Central  Google Scholar 

  7. Kogan JR, Hatala R, Hauer KE, Holmboe E. Guidelines: the do’s, don’ts and don’t knows of direct observation of clinical skills in medical education. Perspect Med Educ. 2017;6:286–305.

    Article  Google Scholar 

  8. Nash RA, Winstone NE. Responsibility-sharing in the giving and receiving of assessment feedback. Front Psychol. 2017;8:1519.

    Article  Google Scholar 

  9. Guerrasio J, Brooks E, Rumack CM, Aagaard EM. The evolution of resident remedial teaching at one institution. Academic Med. 2019;94:1891–4.

    Article  Google Scholar 

  10. Kalet A, Chou CL. Remediation in medical education: a mid-course correction. 2014. https://link.springer.com/book/10.1007%2F978-1-4614-9025-8.

  11. Sawyer T, Gray M, Chabra S, Johnston LC, Carbajal MM, Gillam-Krakauer M, et al. Milestone level changes from residency to fellowship: a Multicenter Cohort Study. J Grad Med Educ. 2021;13:377–84.

    Article  Google Scholar 

  12. Klein R, Julian KA, Snyder ED, Koch J, Ufere NN, Volerman A, et al. Gender bias in resident assessment in graduate medical education: review of the literature. J Gen Intern Med. 2019;34:712–9.

    Article  Google Scholar 

  13. Sukhera J, Wodzinski M, Milne A, Teunissen PW, Lingard L, Watling C. Implicit bias and the feedback paradox: exploring how health professionals engage with feedback while questioning its credibility. Acad Med. 2019;94:1204–10.

    Article  Google Scholar 

  14. Wolpaw J, Saddawi-Konefka D, Dwivedi P, Toy S. Faculty underestimate resident desire for constructive feedback and overestimate retaliation. J Educ Perioper Med. 2019;21:E634.

    PubMed  PubMed Central  Google Scholar 

  15. ACGME. ACGME program requirements for graduate medical education in neonatal-perinatal medicine. 2020. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/329_NeonatalPerinatalMedicine_2020.pdf?ver=2020-06-29-162707-410.

  16. French HM, Leeman KT, Wambach JA, Malik SK, ONTPD Fellowship Directors Writing Group, Reber KM. Essentials of neonatal-perinatal medicine fellowship: an overview. J Perinatol. 2022;42:269–76 https://doi.org/10.1038/s41372-021-00973-3.

  17. Sargeant J, Mann K, Manos S, Epstein I, Warren A, Shearer C, et al. R2C2 in action: testing an evidence-based model to facilitate feedback and coaching in residency. J Grad Med Educ. 2017;9:165–70.

    Article  Google Scholar 

  18. Li ST. The promise of milestones: are they living up to our expectations? J Grad Med Educ. 2017;9:54–7.

    Article  Google Scholar 

  19. Downing SM. Validity: on meaningful interpretation of assessment data. Med Educ. 2003;37:830–7.

    Article  Google Scholar 

  20. Moon TR. Project implicit - Implicit Association Test (IAT) Harvard University. https://implicit.harvard.edu/implicit/takeatest.html.

  21. Raj JM, Thorn PM. A faculty development program to reduce rater error on milestone-based assessments. J Grad Med Educ. 2014;6:680–5.

    Article  Google Scholar 

  22. Roch SG, Woehr DJ, Mishra V, Kieszczynska U. Rater training revisited: an updated meta-analytic review of frame-of-reference training. J Occup Organ Psychol. 2012;85:370–95.

    Article  Google Scholar 

  23. Baker K, Haydar B, Mankad S. A feedback and evaluation system that provokes minimal retaliation by trainees. Anesthesiology. 2017;126:327–37.

    Article  Google Scholar 

  24. Dweck C. Mindset the new psychology of success. New York: Random House; 2016.

  25. Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33:961–73.

    Article  Google Scholar 

  26. Moroz A, Horlick M, Mandalaywala N, Stern DT. Faculty feedback that begins with resident self-assessment: motivation is the key to success. Med Educ. 2018;52:314–23.

    Article  Google Scholar 

  27. Cusack J, Fawke J. Neonatal resuscitation: are your trainees performing as you think they are? A retrospective review of a structured resuscitation assessment for neonatal medical trainees over an 8-year period. Arch Dis Child Fetal Neonatal Ed. 2012;97:F246–8.

    Article  Google Scholar 

  28. Kane SK, Lorant DE. Creation and validation of tool to assess resident competence in neonatal resuscitation. Acad Pediatr. 2019;19:394–8.

    Article  Google Scholar 

  29. DeMeo SD, Katakam L, Goldberg RN, Tanaka D. Predicting neonatal intubation competency in trainees. Pediatrics 2015;135:e1229–36.

    Article  Google Scholar 

  30. Volz S, Stevens TP, Dadiz R. A randomized controlled trial: does coaching using video during direct laryngoscopy improve residents’ success in neonatal intubations? J Perinatol. 2018;38:1074–80.

    Article  Google Scholar 

  31. Ghoneim N, Dariya V, Guffey D, Minard CG, Frugé E, Harris LL, et al. Teaching NICU fellows how to relay difficult news using a simulation-based curriculum: does comfort lead to competence? Teach Learn Med. 2019;31:207–21.

    Article  Google Scholar 

  32. Ten Cate O, Hart D, Ankel F, Busari J, Englander R, Glasgow N, et al. Entrustment decision making in clinical training. Acad Med. 2016;91:191–8.

    Article  Google Scholar 

  33. El-Haddad C, Damodaran A, McNeil HP, Hu W. The ABCs of entrustable professional activities: an overview of ‘entrustable professional activities’ in medical education. Intern Med J. 2016;46:1006–10.

    Article  CAS  Google Scholar 

  34. Ten Cate O, Regehr G. The power of subjectivity in the assessment of medical trainees. Acad Med. 2019;94:333–7.

    Article  Google Scholar 

  35. Parker T, Guiton G, Jones M. Choosing entrustable professional activities for neonatology: a Delphi study. J Perinatol. 2017;37:1335–40.

    Article  CAS  Google Scholar 

  36. O’Dowd E, Lydon S, O’Connor P, Madden C, Byrne D. A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011-2018. Med Educ. 2019;53:234–49.

    Article  Google Scholar 

  37. Edgar L, Roberts S, Holmboe E. Milestones 2.0: a step forward. J Grad Med Educ. 2018;10:367–9.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX, USA

    Melissa M. Carbajal

  2. Departments of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Rita Dadiz & Patricia Chess

  3. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Taylor Sawyer, Erin Cicalese, Megan Gray & Jennifer Wambach

  4. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Sara Kane

  5. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Mackenzie Frost & Heather French

  6. Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA

    Robert Angert

  7. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Kris Reber & Elizabeth Bonachea

  8. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Karena Lawrence

  9. Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Melissa Bauserman

  10. Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA

    Misty Good

  11. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Brittany Schwarz

  12. Department of Pediatrics, UH Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Allison Payne

  13. Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA

    Maria Gillam-Krakauer

  14. Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri School of Medicine, Columbia, MO, USA

    Jotishna Sharma

  15. Department of Pediatrics, University of Connecticut School of Medicine; Division of Neonatology, Connecticut Children’s, Farmington, CT, USA

    Jennifer Trzaski

  16. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    Lindsay Johnston

  17. Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Patricia Chess

  18. Division of Neonatology and Developmental Biology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Josephine Enciso

  19. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA

    Alison Falck

  20. Division of Neonatology, Duke University Medical Center, Durham, NC, USA

    Susan Izatt

  21. Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA

    Autumn Kiefer & M. Cody Smith

  22. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Kristen Leeman

  23. Department of Pediatrics, Hackensack Meridian Health School of Medicine, Nutley, NJ, USA

    Sabrina Malik

  24. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Patrick Myers

  25. Department of Pediatrics, Division of Neonatology, University at Buffalo, Buffalo, NY, USA

    Jayasree Nair

  26. Department of Pediatrics, Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA

    Deirdre O’Reilly

  27. Department of Pediatrics, University of Michigan Medical School, Michigan Medicine, Ann Arbor, MI, USA

    Kate Stanley

  28. Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Margarita Vasquez

  29. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    C. Lydia Wraight

Authors
  1. Melissa M. Carbajal
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  2. Rita Dadiz
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  3. Taylor Sawyer
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  4. Sara Kane
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  5. Mackenzie Frost
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  6. Robert Angert
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Consortia

ONTPD Fellowship Directors Writing Group

  • Heather French
  • , Kris Reber
  • , Erin Cicalese
  • , Karena Lawrence
  • , Melissa Bauserman
  • , Misty Good
  • , Brittany Schwarz
  • , Allison Payne
  • , Maria Gillam-Krakauer
  • , Jotishna Sharma
  • , Elizabeth Bonachea
  • , Jennifer Trzaski
  • , Lindsay Johnston
  • , Patricia Chess
  • , Josephine Enciso
  • , Alison Falck
  • , Megan Gray
  • , Susan Izatt
  • , Autumn Kiefer
  • , Kristen Leeman
  • , Sabrina Malik
  • , Patrick Myers
  • , Jayasree Nair
  • , Deirdre O’Reilly
  • , M. Cody Smith
  • , Kate Stanley
  • , Margarita Vasquez
  • , Jennifer Wambach
  •  & C. Lydia Wraight

Contributions

Each contributing author was responsible for writing a section of the manuscript. The manuscript was compiled by first author and group edited by the authors over several Zoom meetings. Senior author wrote a portion of the manuscript and provided oversight for editing. First author finalized edits and references, submitted manuscript, and corresponded with journal editor.

Corresponding author

Correspondence to Melissa M. Carbajal.

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Competing interests

The authors declare no competing interests.

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Cite this article

Carbajal, M.M., Dadiz, R., Sawyer, T. et al. Part 5: Essentials of Neonatal-Perinatal Medicine Fellowship: evaluation of competence and proficiency using Milestones. J Perinatol 42, 809–814 (2022). https://doi.org/10.1038/s41372-021-01306-0

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  • DOI: https://doi.org/10.1038/s41372-021-01306-0

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