UNC GUIDE TO PEDIATRIC MILESTONE RESIDENT EVALUATIONS IN THE PED
2015-2016
We have been asked to evaluate the resident on 11 specific Pediatric Milestones and 3 general PEM specific
competencies*.
As you think about the residents both during the rotation and at the time you give your final assessment I thought
it might be helpful to think about 4 broad skill categories:
1. Information Gathering
2. Ability to organize and prioritize
3. Decision making
4. Ability to function autonomously
I have then linked those general skill categories to 4 KEY associated Pediatric Milestones as well as other Pediatric
Milestones that apply to the particular skill category. Information and notes to help bring meaning to these
milestones and to help you think about your evaluation also follow. This information is borrowed heavily from the
2014-15 Cincinnati Children’s Hospital Medical Center Pediatric Emergency Medicine Guide to Resident Evaluations
in the ED (with the blessings of Brad Sobolewski, MD – the document’s chief author).
http://www.pemcincinnati.com/orientation/wp-content/uploads/2014/07/2014-15-detailed-milestonesexplanation-and-guide.pdf
I hope that this document will continue to be improved upon with the on-going input of UNC PEM attendings,
resident education leadership, and the residents themselves with the goal of making the resident evaluation
process more transparent and the feedback more meaningful.
*UNC Peds ER/ Peds Acute Care Pediatric Milestone Rotation Evaluation with abbreviations
PATIENT CARE milestones
1. Ability to gather essential and accurate information about each patient (PC1)
2. Ability to organize and prioritize responsibilities to provide patient care that is safe,
effective and efficient (PC2)
3. Ability to make informed diagnostic and treatment decisions that lead to optimal clinical
judgment (PC4)
4. Ability to make and carry out management plans (PC5)
MEDICAL KNOWLEDGE milestones
5. Ability to find, review and use scientific evidence to enhance own knowledge, optimally
care for patients and eventually teach others (MK1)
PRACTICE-BASED LEARNING AND IMPROVEMENT milestones
6. Ability to use feedback to improve daily practice (PBLI4)
PROFESSIONALISM milestones
7. Demonstrates exemplary Professional Conduct : has smooth interactions with everyone,
has sense of duty and accountability (PROF3)
8. Demonstrates self-awareness of his/her own limitations and seeks help when appropriate
(PROF 4)
9. Inspires trust from colleagues by demonstrating attention to detail and knowledge of
patients as well as own limitations (PROF5)
10. Accepts ambiguity of clinical medicine and uses appropriate resources as needed to deal
with uncertainty (PROF6)
SYSTEMS-BASED PRACTICE milestones
11. Coordinates patient care within the health care system relevant to their clinical specialty
(SBP1)
UNC GUIDE TO PEDIATRIC MILESTONE RESIDENT EVALUATIONS IN THE PED
2015-2016
PEDIATRIC ED SPECIFIC *
12. Proficient procedural skills, considers patient need when planning and
performing the procedure.
13. Resident demonstrates a high level of autonomy for level of training, consistently able to
recognize and manage seriously ill and injured patients
14. Appropriately consults subspecialists and other medical professionals with specific
questions and communicates effectively
1. INFORMATION GATHERING: Can the resident gather essential and accurate information
through interview and physical exam and use that information to formulate a differential and
final diagnosis?
Key Milestone: Patient Care 1 (PC1) Ability to gather essential and accurate information about each patient
Additional Mapped Milestones: Professionalism 3 (PROF3) Demonstrates exemplary Professional Conduct:
has smooth interactions with everyone, has sense of duty and accountability. Resident communicates well with everyone –
patients, families, staff and consultants.
Novice (1)
Early
Beginner (2)
Competent (3)
Identifies pertinent positives /negatives but differential diagnosis is broad
Intermediate
Proficient (4)
Expert (5)
Gathers too much or too little information and has difficulty forming differential
diagnoses
Gathers and filters information to develop appropriate differential diagnosis
Arrives at precise diagnosis except in complex or uncommon problems
Advanced
Always discriminates among diagnoses with subtle distinguishing features
In order to effectively assess this milestone it is suggested you:
 Don’t assume that the resident is only using pattern recognition if they jump to a
diagnosis quickly. Seek to understand their thought process and you may find that they
arrived at precisely the right diagnosis because of their advanced filtering skills.
UNC GUIDE TO PEDIATRIC MILESTONE RESIDENT EVALUATIONS IN THE PED
2015-2016
2. ORGANIZING & PRIORITIZING: Can the resident organize and prioritize responsibilities in
order to provide safe, effective and efficient patient care? How well does the resident manage
his/her time, multitask and deal with interruptions? Is documentation timely and complete?
Key Milestone: Patient Care 2 (PC2) Ability to organize and prioritize responsibilities to provide patient care
that is safe, effective and efficient
Additional Mapped Milestones:
Professionalism 3 (PROF3) Demonstrates exemplary Professional Conduct: has smooth interactions with
everyone, has sense of duty and accountability. Resident communicates well with everyone – patients, families, staff and
consultants.
Systems-Based Practice 1 (SBP1) Coordinates patient care within the health care system relevant to their
clinical specialty. Resident follows through with verbal communication; documents discussed discharge plans; completes
medical record in a timely manner and communicates with primary or specialty care providers as indicated.
Novice (1)
Early
Beginner (2)
Competent (3)
Cares for 2-3 patients simultaneously
Intermediate
Proficient (4)
Expert (5)
Only able to focus on single patients
Prioritizes when caring for multiple straightforward patients
Prioritizes when caring for multiple levels of acuity, but only their own patients
Advanced
Prioritizes own patients while simultaneously considering the needs of the ED as
a supervising physician might
In order to effectively assess this milestone it is suggested you:
 Try to understand how the resident is prioritizing their work
 Direct nurses and other care providers to the resident first with questions/issues about
patients, then assess how the resident dealt with the interruption.
 Attempt to discern what makes a resident less efficient. Is it volume? Acuity?
Interruptions? Exhaustion? All of the above?
UNC GUIDE TO PEDIATRIC MILESTONE RESIDENT EVALUATIONS IN THE PED
2015-2016
3. DECISION MAKING: Can the resident make a plan of care and carry it out; and ultimately can
they do so without prompts from supervisors or institutional culture (e.g. “that is what we
usually do at UNC”)?
Key Milestone: Patient Care 5 (PC5) Ability to make and carry out management plans
Additional Mapped Milestones:
Patient Care 4 (PC4) Ability to make informed diagnostic and treatment decisions that lead to optimal clinical
judgment
Medical Knowledge 1 (MK1) Ability to find, review and use scientific evidence to enhance own knowledge,
optimally care for patients and eventually teach others (MK1)
Novice (1)
Early
Beginner (2)
Competent (3)
Develops plan with heavy reliance on supervisor input
Intermediate
Proficient (4)
Expert (5)
Plans are based solely on direction from supervisor
Develops plan independently for most common conditions
Develops plan independently for all common conditions and some complex
ones
Advanced
Develops plans independently for all conditions
In order to effectively assess this milestone it is suggested you:
 Try to provide as much autonomy in decision making as possible.
 Avoid consciously “prompting” residents so that they arrive at the plan that you prefer
 Attempt to understand why the resident has made certain decisions about patient care, and
provide education when there are gaps in their knowledge.
 Accept that sometimes the resident’s plan may be different from yours. And allow variation
when supported by the literature, and when it is safe to do so within the context of the
individual patient’s care and the climate of the ED as a whole.
UNC GUIDE TO PEDIATRIC MILESTONE RESIDENT EVALUATIONS IN THE PED
2015-2016
4. ABILITY TO FUNCTION AUTONOMOUSLY: Can you count on the resident to carry out a given
task, make decisions or follow-through on any other aspect of clinical care in the ED with
minimal or no supervision by the end of their training? Trustworthy residents are generally
aware of their own limitations, conscientious (thorough and dependable in follow-through of
tasks) and truthful.
Key Milestone: PROFESSIONALISM (PROF5) Inspires trust from colleagues by demonstrating attention
to detail and knowledge of patients as well as own limitations
Additional Mapped Milestones:
Practiced-based Learning and Improvement 4 (PBLI 4) Ability to make informed diagnostic and
treatment decisions that lead to optimal clinical judgment
Professionalism 4 (PROF 4) Demonstrates self-awareness of his/her own limitations and seeks help when
appropriate
Professionalism 6 (PROF 6) Accepts ambiguity of clinical medicine and uses appropriate resources as needed
to deal with uncertainty
Novice (1)
Early
Beginner (2)
Competent (3)
Only sometimes aware of limitations, doesn’t always know when to seek help,
frequently requires prompting to complete tasks
Intermediate
Proficient (4)
Expert (5)
Unaware of own limitations, usually requires prompting to complete tasks
Has insight into limitations, seeks help appropriately, only occasionally requires
prompting to complete tasks
Openly communicates limitations, needs help only for complex problems,
rarely requires prompting to complete tasks
Advanced
Consistently uses limitations to improve, supervises and helps others,
proactively completes tasks without prompting based on extensive
experience
In order to effectively assess this milestone it is suggested you:
 Encourage residents to construct a patient care to-do list and review it
 Make sure residents know you are available for help and questions if they get in over their head.
Don’t mistake lack of questions for confidence (or competence) since some residents will be
cautious about “bothering you” and others will be afraid to show they don’t know.
 Be transparent in your communication regarding how much autonomy you are providing in a
given scenario
 Foster a culture where early learners are not pressured to be autonomous before they’re ready
while allowing intermediate/ advanced learners to cope with uncertainty
 Provide as much autonomy as you can within the confines of safe patient care by consciously
avoiding the “guess what I’m thinking” and “do what I say only” games.
 Do your own do diligence and cross-check /double-check data reported verbally by a resident