title: Targeting Simulation-Based Assessment for the Pediatric Milestones: A Survey of Simulation Experts and Program Directors.
abstract: OBJECTIVE
  To determine which of the 21 general pediatrics milestone subcompetencies are most difficult to assess using traditional methodologies and which are best suited to simulation-based assessment.
  
  
  METHODS
  We surveyed 2 samples: pediatric simulation experts and pediatric program directors. Respondents were asked about current use of simulation for assessment and to select 5 of the 21 pediatric subcompetencies most difficult to assess using traditional methods and the 5 best suited to simulation-based assessment. Spearman rank correlation was used to determine a correlation between how the 2 samples ranked the subcompetencies.
  
  
  RESULTS
  Forty-eight percent (29 of 60) simulation experts and 20% (115 of 571) program directors completed the survey. Few respondents reported using simulation for summative assessment. There are clear differences across the pediatric subcompetencies in perceived difficulty of assessment and suitability to simulation-based assessment. The 3 most difficult to assess subcompetencies were "recognize ambiguity," "demonstrate emotional insight," and "identify one's own strengths and deficiencies." The subcompetencies most suitable to assessment using simulation were "interprofessional teamwork," "clinical decision making," and "effective communication." Program directors and simulation experts had high agreement for both questions: difficult to assess (rho = 0.76, P < .001) and suitable to simulation-based assessment (rho = 0.94, P < .001).
  
  
  CONCLUSIONS
  Several general pediatrics milestone subcompetencies were identified by pediatric simulation experts and pediatric program directors as difficult to assess using current methodologies and as amenable to simulation-based assessment. The pediatric simulation community should target development of simulation-based assessment tools to these areas.
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine/The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine. Electronic address: mallol@mmc.org.
authors.forename: Leah A
authors.initials: LA
authors.lastname: Mallory
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, Drexel University College of Medicine/St Christopher's Hospital for Children, Philadelphia, Pa.
authors.forename: Sharon
authors.initials: S
authors.lastname: Calaman
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Lee White
authors.affiliation: Section of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
authors.forename: Cara
authors.initials: C
authors.lastname: Doughty
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Feinberg School of Medicine at Northwestern University, Chicago, Ill.
authors.forename: Karen
authors.initials: K
authors.lastname: Mangold
authors.affiliation: Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lopreiato
authors.affiliation: Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
authors.affiliation: Division of Emergency Medicine and Transport, Department of Pediatrics, Children's Hospital Los Angeles/Keck School of Medicine at University of Southern California, Los Angeles, Calif.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Chang
mesh_terms: D002983:Clinical Competence; D000066491:Clinical Decision-Making; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D010372:Pediatrics / Q000193:education*; D000066908:Simulation Training; D011795:Surveys and Questionnaires
keywords: competency-based assessment; pediatrics milestones; residency training; simulation