title: The pediatrics milestones: initial evidence for their use as learning road maps for residents.
abstract: OBJECTIVE
  As the next step in competency-based medical education, the Pediatrics Milestone Project seeks to provide a learner-centered approach to training and assessment. To help accomplish this goal, this study sought to determine how pediatric residents understand, interpret, and respond to the Pediatrics Milestones.
  
  
  METHODS
  Cognitive interviews with 48 pediatric residents from all training levels at 2 training programs were conducted. Each participant reviewed one Pediatrics Milestone document (PMD). Eight total Pediatrics Milestones, chosen for their range of complexity, length, competency domain, and primary author, were included in this study. Six residents, 2 from each year of residency training, reviewed each PMD. Interviews were transcribed and coded using inductive methods, and codes were grouped into themes that emerged.
  
  
  RESULTS
  Four major themes emerged through coding and analysis: 1) the participants' degree of understanding of the PMDs is sufficient, often deep; 2) the etiology of participants' understanding is rooted in their experiences; 3) there are qualities of the PMD that may contribute to or detract from understanding; and 4) participants apply their understanding by noting the PMD describes a developmental progression that can provide a road map for learning. Additionally, we learned that residents are generally comfortable being placed in the middle of a series of developmental milestones. Two minor themes focusing on interest and practicality were also identified.
  
  
  CONCLUSIONS
  This study provides initial evidence for the Pediatrics Milestones as learner-centered documents that can be used for orientation, education, formative feedback, and, ultimately, assessment.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. daniel.schumacher@bmc.org
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Schumacher
authors.forename: Kadriye O
authors.initials: KO
authors.lastname: Lewis
authors.forename: Ann E
authors.initials: AE
authors.lastname: Burke
authors.forename: M Lynne
authors.initials: ML
authors.lastname: Smith
authors.forename: Jayna B
authors.initials: JB
authors.lastname: Schumacher
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Pitman
authors.forename: Stephen
authors.initials: S
authors.lastname: Ludwig
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Hicks
authors.forename: Susan
authors.initials: S
authors.lastname: Guralnick
authors.forename: Robert
authors.initials: R
authors.lastname: Englander
authors.forename: Bradley
authors.initials: B
authors.lastname: Benson
authors.forename: Carol
authors.initials: C
authors.lastname: Carraccio
mesh_terms: D003162:Competency-Based Education / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007858:Learning; D010372:Pediatrics / Q000193:education*; D036301:Qualitative Research