Beyond Competencies and Milestones: Adding Meaning Through Context

In this issue of the Journal, the Pediatrics Milestone Working Group describes an innovative and unique process for addressing the charge from the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Pediatrics to further define the 6 ACGME competencies along with performance standards for our specialty. After 18 months of intense learning, discussion, writing, and rewriting, we have a first iteration of our work. This is not the end but rather the beginning. Where do we go from here? In this brief commentary we hope to provide the background and rationale for our suggested next steps.