Pediatric Program Director Minimum Milestone Expectations Before Allowing Supervision of Others and Unsupervised Practice

Background: The Accreditation Council for Graduate Medical Education requires semiannual Milestone reporting on all residents. Milestone expectations of performance are unknown. Objective: To determine pediatric program director (PD) minimum Milestone expectations for residents before being ready to supervise and before being ready to graduate. Methods: Mixed methods survey of pediatric PDs on their programs’ Milestone expectations before residents are ready to supervise and before they are ready to graduate, and in what ways PDs use Milestones to make supervision and graduation decisions. If programs had no established Milestone expectations, PDs indicated expectations they considered for use in their program. Mean minimum Milestone level expectations were adjusted for program size, region, and clustering of Milestone expectations by program were calculated for before supervise and before graduate. Free-text questions were analyzed using thematic analysis. Results: The response rate was 56.8% (113 of 199). Most programs had no required minimum Milestone level before residents are ready to supervise (80%; 76 of 95) or ready to graduate (84%; 80 of 95). For readiness to supervise, minimum Milestone expectations PDs considered establishing for their program were highest for humanism (2.46; 95% confidence interval [CI], 2.21–2.71) and professionalization (2.37; 95% CI, 2.15–2.60). Minimum Milestone expectations for graduates were highest for help-seeking (3.14; 95% CI, 2.83–3.46). Main themes included the use of Milestones in combination with other information to assess learner performance and Milestones are not equally weighted when making advancement decisions. Conclusions: Most PDs have not established program minimum Milestones, but would vary such expectations according to competency.