75. DO PEDIATRIC EMERGENCY MEDICINE FELLOWS MEET THE MILESTONE TARGETS FOR GRADUATION?

The ACGME Milestone Project is a competency-based assessment tool. Subcompetencies (SC) are scored on a 5-point scale, and level 4 is recommended for graduation. The 2018 Milestones Report found that across subspecialties, not all graduates are attaining a level 4 for every SC. To describe the number of pediatric emergency medicine (PEM) fellows who achieve level 4 in all 23 SC at graduation and to identify SC and predictive factors where a level 4 is not achieved. This is a multicenter, retrospective cohort study of PEM fellows. Program directors provided de-identified milestone reports from 2015-2018. Descriptive analysis of milestone scores at graduation was performed. Demographics were compared between fellows who did and did not meet level 4 at graduation for each SC. Sub-analyses assessed differences in residency and first year milestone scores and the rate of milestone attainment between fellows who did and did not attain level 4 at graduation. Data from 48 PEM fellowship programs yielded graduation scores for 392 fellows (62% of total). 87% completed pediatric residency and 60% were female. Residency scores were available for 45 fellows. There were no SC in which all fellows attained at least level 4 at graduation; the range of fellows scoring < level 4 per SC was 7-39%. (Table 1) 67% of fellows did not attain level 4 on one or more of the 23 SC at graduation. While some fellows failed to attain a level 4 on up to all 23 SC, 26% failed to meet level 4 on only 1 or 2 SC. In 19/23 SC, residency and/or first year milestones scores were significantly lower for those who did not attain level 4 at graduation compared to those who did (mean difference 0.74 points). Those who did not attain level 4 at graduation had a significantly faster rate of improvement in milestone scores for 10/23 SC compared to those who did attain level 4. In our sample, 67% of PEM fellows did not attain level 4 for at least 1 of the 23 SC at graduation. Low scores during residency or early in fellowship may predict difficulty in meeting level 4 by fellowship completion. [ABSTRACT FROM AUTHOR]