Developmental Milestones Pediatrics

Stanford Pediatrics Residency Program Page 1 of 8

* Approximate time frame that a pediatrics resident should achieve that milestone (in months)

Developmental Milestones in Pediatrics

I. PATIENT CARE

Historical Data Gathering * Assessment Consistently and reliably acquire accurate and relevant history from the appropriate source in an efficient, prioritized and hypothesis driven fashion. Sources could include the patient, the patients family, other care providers, other healthcare providers; e.g. EMTs, outside physicians, nurses, and medical records.

6 Direct observation Clinical vignettes

Obtain relevant historical subtleties that inform and prioritize both differential diagnoses and diagnostic plans, including sensitive, complicated, and detailed information that may not be volunteered by the patient or the patients family.


Role model gathering subtle and reliable information for junior members of the health care team.


Performing a Physical Exam * Assessment Consistently and reliably perform an accurate physical examination appropriately targeted to the patients complaints and medical conditions.

6 Direct observation Simulation

Accurately track important changes in the physical examination over time in the inpatient and outpatient settings.

6 Direct observation

Demonstrate and teach how to elicit physical findings for junior members of the health care team.

18 Direct observation Simulation

Identify subtle or unusual physical findings that inform clinical decision making.

30 Direct observation

Clinical Reasoning * Assessment Tools Synthesize available data, including interview, physical examination, and preliminary lab data to define each patients central clinical problem.

6 Direct Observation Clinical Vignettes/case conference presentation Simulation Standardized tests

Develop prioritized differential diagnoses, and evidence-based diagnostic and therapeutic plans for common inpatient and ambulatory problems.

12

Make appropriate clinical decisions based on the results of advanced diagnostic tests.

18

Modify differential diagnosis and care plan based on clinical course and data as appropriate.

24

Recognize disease presentations that deviate from common patterns and that require complex decision making.

30

Patient Management * Assessment Tools



Consistently and reliably recognize the situations with a need for urgent or emergent medical care.

6 Simulation Direct observation Multisource feedback Standardized tests Clinical vignettes

Consistently and reliably recognize when to seek additional guidance.

6

With supervision, manage patients with complex pediatric disorders.

12

Initiate management and stabilize patients with emergent medical issues.

12

Independently manage patients with a broad spectrum of clinical disorders seen in the practice of general pediatrics.

36

Manage complex or rare medical conditions. 36 Customize care in the context of the patients culture and overall health.

36

Consultative Care * Assessment Tools Provide specific, responsive consultation to other services.

18 Direct observation Multisource feedback Clinical vignettes

Provide pediatric consultation for patients with more complex clinical problems requiring detailed risk assessment.

36

Invasive Procedures * Assessment Tools Appropriately perform invasive procedures and provide post procedure care.***

R-1 R-2 R-3

0-36 Direct observation Simulation **See description of expectations for specific procedures per year of training

II. MEDICAL KNOWLEDGE

Knowledge of Core Content * Assessment Tools Consistently and reliably demonstrate an understanding of the relevant pathophysiology for common medical conditions.

6 Direct observation Chart audit Standardized tests Clinical vignettes

Demonstrate sufficient knowledge to diagnose and treat common conditions that require hospitalization.

12

Demonstrate sufficient knowledge to evaluate common ambulatory conditions and to prescribe appropriate therapy.

12

Demonstrate sufficient knowledge to initiate treatment of emergent and undifferentiated conditions.

12

Demonstrate sufficient knowledge to provide appropriate anticipatory guidance in the ambulatory setting.

12

Demonstrate sufficient knowledge to provide 12



discharge instructions for patients with common clinical problems. Demonstrate sufficient knowledge to provide discharge instructions for patients with complex clinical issues.

24

Demonstrate sufficient knowledge to identify and initiate treatment of medical conditions that require intensive care.

24

Demonstrate sufficient knowledge to evaluate complex or rare medical conditions and multiple coexisting conditions.

36

Demonstrate an understanding of the pathophysiology of complex or uncommon medical conditions.

36

Demonstrate sufficient knowledge of sociobehavioral sciences, including but not limited to medical ethics, economics, and educational methods.

36

Knowledge of Diagnostic Tests * Assessment Tools Demonstrate an understanding of the indications for and basic interpretation of common diagnostic tests, including but not limited to: routine blood chemistries, hematologic studies, coagulation tests, arterial blood gasses, urinalysis, chest radiographs, ECGs, and microbiology tests.

12 Standardized tests Clinical vignettes Direct observation

Demonstrate an understanding of the indications for and basic interpretation of more advanced diagnostic tests, including but not limited to echocardiograms, CT scans, MRIs, pulmonary function tests.

18 Standardized tests Direct observation Clinical vignettes Multisource feedback

III. PRACTICE-BASED LEARNING AND IMPROVEMENT

Acquires the Best Evidence * Assessment Tools Demonstrate the ability to access medical information resources to answer clinical questions and support decision making.

12 Clinical vignettes Direct observation Multisource feedback Clinical conference participation and evaluation

Search effectively and efficiently for original clinical research articles and summary references.

12

Appraise the quality of medical information resources and use those resources with discrimination.

36



Appraises Medical Evidence * Assessment Tools With assistance, appraise study design and statistical analysis in research papers.

12 Direct observation Research project design and evaluation

With assistance, appraise clinical guidelines. 12 Independently appraise study design, conduct, and statistical analysis in research papers.

36

Independently appraise clinical guidelines, particularly for bias and cost benefit analysis.

36

Applies Medical Evidence to Decision Making for Patients on Individual Basis

* Assessment Tools

Demonstrate the ability to determine appropriateness of clinical evidence for an individual patient.

24 Direct observation Multisource feedback Conference evaluation Clinical vignettes

Communicate risks and benefits of alternative interventions to patients and families.

36

Integrate clinical evidence and family preferences into clinical decision making.

36

Asks Appropriate Questions for Emerging Information Needs

* Assessment Tools

Identify learning needs (clinical questions) as they emerge in patient care areas.

12 Clinical vignettes Direct observation Multisource feedback

Clearly and precisely articulate clinical questions 24 Track, pursue, and reflect on clinical questions in a systematic manner.

36

Incorporates Feedback Positively * Assessment Tools Respond productively to feedback from all members of the health care team.

12 Multisource feedback Self assessment tool Mentored self reflection

Actively seek feedback from all members of the health care team.

12

Capably develop plans for improvement using formative feedback.

24

Improves via Self-Assessment * Assessment Tools Maintain self awareness in clinical situations in real time and adapts to situational needs.

24 Multisource feedback Self assessment tool Mentored self reflection

Reflect on interactions that were difficult and decisions with suboptimal outcomes and responds with actions to future interactions, i.e. demonstrates emotional intelligence and insight.

36

Participates in the Education of the Entire Health Care Team

* Assessment Tools

Actively participate in teaching conferences. 3 Multisource feedback



Establish expectations and provide feedback when supervising interns and/or medical students

24

Provide teaching points while delivering clinical care to patients and lake a leadership role in the education of all members of the health care team.

30 Direct observation Teaching evaluations

Participates in Quality Improvement * Assessment Tools Appreciate the responsibility a physician has to assess and improve care for his/her patients.

12 Direct observation Self reflection Quality project review

Actively participate in advocacy project. 12 Design and/or implement a quality improvement project.

24 -36

Attend a hospital quality improvement committee meeting and reflect on the process at that level.

36

IV. INTERPERSONAL AND COMMUNICATION SKILLS

Communicate Effectively * Assessment Tools Consistently and reliably provide timely and effective communication with families and patients.

12 Multisource feedback Direct observation Mentored self reflection

Effectively create rapport with patients and families. 12 Build effective therapeutic relationships with patients and families.

24

Engage families and, where appropriate, patients in clinical decision making when straightforward.

24

Effectively teach patients and families about specific disease processes and provide appropriate discharge education and anticipatory guidance.

24

Engage families and, where appropriate, patients in clinical decision making when those decisions are ambiguous, difficult, or controversial.

36

Counsel families about risks and benefits of tests and procedures, and therapeutic options, including cost awareness and resource requirements.

36

Role model effective communication in challenging situations.

36

Intercultural Sensitivity * Assessment Tools Effectively use interpreter services in the clinical setting including patient education.

6 Multisource feedback

Demonstrate sensitivity to differences in patients including, but not limited to, race, culture, gender, sexual orientation, literacy, socioeconomic status, and religion.

12

Actively seek to understand patient and family differences and views. Reflect this understanding in respectful communication and shared decision making with the patient and health care team.

30



Transitions of Care * Assessment Tools Effectively communicate with other care providers to maintain appropriate continuity during transitions of care.

12 Multisource feedback Direct observation Signout feedback

Role model effective communication with next care provider team during transitions of patient care.

24

Interprofessional Team * Assessment Tools Deliver appropriate, succinct, hypothesis driven oral presentations.

6 Multisource feedback Direct observation Effectively communicate the plan of care to the entire

health care team and the patients family. 12

Engage in collaborative communication with all the members of the health care team.

18

Consultation * Assessment Tools Request consultative services in an effective manner. 6 Multisource feedback

Chart audit

Clearly communicate the role of the consultant to the patients family, maintaining the primary service relationship.

12

Communicate consultative recommendations to the primary care team effectively.

24

Health Records * Assessment Tools Consistently and reliably maintain accurate, complete and legible records in a timely manner congruent with medical records requirements and standards.

6 Multisource feedback Chart audit

Ensure succinct, relevant, patient specific written communication.

24

V. PROFESSIONALISM

Demonstrate Personal Accountability * Assessment Tools Consistently and reliably dress and behave professionally

0 Direct observation Multisource feedback Mentored self reflection

Consistently and reliably maintain appropriate professional relationships with patients, families, staff, and colleagues.

0

Consistently and reliably promptly complete clinical, administrative, and educational assignments.

6

Recognize personal limitations that may affect professional performance, and address them.

6

Recognize professional limitations and request assistance or supervision appropriately.

6

Recognize the need to assist colleagues and do so. 6 Respond promptly and appropriately to clinical responsibilities including but not limited to calls and pages.

6

Demonstrate Adherence to Basic Ethical Principles * Assessment Tools



Consistently and reliably document and report clinical information truthfully.

0 Multisource feedback Direct observation Mentored self reflection

Consistently and reliably accept personal errors and honestly acknowledge them.

0

Adhere consistently to hospital policies. 0 Demonstrate empathy and compassion to all patients. 0 Treat patients and families with dignity, civility, and respect regardless of race, age, gender, culture, ethnicity, or socioeconomic status.

0

Consistently and reliably demonstrate a commitment to relieve pain and suffering.

3

Provide support (physical, psychological, social, and spiritual) for dying patients and their families.

12

Uphold ethical expectations of research and scholarly activities.

24

Function in a Health Care Team as a Member or Leader

* Assessment Tools

Communicate constructive feedback to members of the health care team.


Recognize and respond to impairment in colleagues or to substandard care via peer review.

18

Lead the healthcare team where patient dignity and autonomy is paramount in importance.

24

Practice Advocacy for Patients * Assessment Tools Maintain patient confidentiality and educate others to do the same.

0 Multisource feedback Direct observation Recognize when it is necessary to advocate for

individual patient needs. 6

Effectively advocate for individual patient needs. 12 Recognize that disparities exist in health care among populations and that they may impact patient care.

12

Embrace the physicians role in assisting the public and the policy makers in understanding health disparities.

24

VI. SYSTEMS-BASED PRACTICE Works Effectively Within the Complex Health Delivery

System * Assessment Tools

Appreciate roles of various health care providers, including, but not limited to, nurses, therapists, case managers, pharmacists, and social workers.


Work effectively as a member within the interprofessional team to ensure safe patient care.

6

Negotiate patient centered care among multiple providers.

18



Manages care across the health care continuum: ambulatory, inpatient services, skilled nursing facilities, etc.

36

Coordinates the skill and activities of all members of the health care team to optimize patient care.

36

Recognizes System Error and Advocates for System Improvement

* Assessment Tools

Identify, reflect on, and learn from critical incidents. 12 Multisource feedback Quality improvement project evaluation

Recognizes issues in the health care system that increase the risk for error including barriers to optimal patient care.

36

Demonstrate an understanding for analysis of system errors and participate in a system-level quality-improvement intervention.

36

Advocates and Practices Cost Effective Care * Assessment Tools Identify costs for common diagnostic or therapeutic tests.

6 Direct observation Standardized tests Reflect awareness of common economic barriers that

impact patient care. 12

Demonstrate an understanding of cost benefit analysis as applied to patient care.

12

Integrate cost awareness and cost benefit analysis into clinical decision making.

36

Documents

Developmental Milestones Pediatrics