Developmental Milestones Pediatrics

Stanford Pediatrics Residency Program
Page 1 of 8
Developmental Milestones in Pediatrics

I. PATIENT CARE
Historical Data Gathering
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.
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
Consistently and reliably perform an accurate physical
examination appropriately targeted to the patients
complaints and medical conditions.
Accurately track important changes in the physical
examination over time in the inpatient and outpatient
settings.
Demonstrate and teach how to elicit physical findings
for junior members of the health care team.
Identify subtle or unusual physical findings that inform
clinical decision making.
Clinical Reasoning
Synthesize available data, including interview, physical
examination, and preliminary lab data to define each
patients central clinical problem.
Develop prioritized differential diagnoses, and
evidence-based diagnostic and therapeutic plans for
common inpatient and ambulatory problems.
Make appropriate clinical decisions based on the
results of advanced diagnostic tests.
Modify differential diagnosis and care plan based on
clinical course and data as appropriate.
Recognize disease presentations that deviate from
common patterns and that require complex decision
making.
Patient Management
*
6
Assessment
Direct observation
Clinical vignettes
18
Direct observation
Clinical vignettes
30
Direct observation
Clinical vignettes
Assessment
Direct observation
Simulation
Direct observation
18
Direct observation
30
Simulation
Direct observation
*
6
12
Assessment Tools
Direct Observation
Clinical Vignettes/case
conference presentation
Simulation
Standardized tests
18
24
30
Assessment Tools
* Approximate time frame that a pediatrics resident should achieve that milestone (in months)

Consistently and reliably recognize the situations with
a need for urgent or emergent medical care.
Consistently and reliably recognize when to seek
additional guidance.
With supervision, manage patients with complex
pediatric disorders.
Initiate management and stabilize patients with
emergent medical issues.
Independently manage patients with a broad spectrum
of clinical disorders seen in the practice of general
pediatrics.
Manage complex or rare medical conditions.
Customize care in the context of the patients culture
and overall health.
Consultative Care
Provide specific, responsive consultation to other
services.
Provide pediatric consultation for patients with more
complex clinical problems requiring detailed risk
assessment.
Invasive Procedures
Appropriately perform invasive procedures and
provide post procedure care.***
R-1
R-2
R-3
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6
Simulation
Direct observation
12
Multisource feedback
12
Standardized tests
36
Clinical vignettes
36
36
*
18
Assessment Tools
Direct observation
36
*
0-36
Clinical vignettes
Assessment Tools
Direct observation
Simulation
**See description of
expectations for specific
procedures per year of
training
II. MEDICAL KNOWLEDGE

Knowledge of Core Content
Consistently and reliably demonstrate an
understanding of the relevant pathophysiology for
common medical conditions.
Demonstrate sufficient knowledge to diagnose and
treat common conditions that require hospitalization.
Demonstrate sufficient knowledge to evaluate
common ambulatory conditions and to prescribe
appropriate therapy.
Demonstrate sufficient knowledge to initiate
treatment of emergent and undifferentiated
conditions.
Demonstrate sufficient knowledge to provide
appropriate anticipatory guidance in the ambulatory
setting.
*
6
Assessment Tools
Direct observation
Chart audit
12
Standardized tests
12
Clinical vignettes
12
12
12

discharge instructions for patients with common
clinical problems.
discharge instructions for patients with complex
clinical issues.
Demonstrate sufficient knowledge to identify and
initiate treatment of medical conditions that require
intensive care.
Demonstrate sufficient knowledge to evaluate
complex or rare medical conditions and multiple
coexisting conditions.
Demonstrate an understanding of the pathophysiology
of complex or uncommon medical conditions.
Demonstrate sufficient knowledge of sociobehavioral
sciences, including but not limited to medical ethics,
economics, and educational methods.
Knowledge of Diagnostic Tests
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.
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.
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24
24
36
36
36
*
12
Assessment Tools
Standardized tests
Clinical vignettes
Direct observation
18
Standardized tests
Direct observation
Clinical vignettes
III. PRACTICE-BASED LEARNING AND IMPROVEMENT

Acquires the Best Evidence
Demonstrate the ability to access medical information
resources to answer clinical questions and support
decision making.
*
12
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
Assessment Tools
Clinical vignettes
Direct observation
Clinical conference
participation and evaluation

Appraises Medical Evidence
With assistance, appraise study design and statistical
analysis in research papers.
With assistance, appraise clinical guidelines.
Independently appraise study design, conduct, and
statistical analysis in research papers.
Independently appraise clinical guidelines, particularly
for bias and cost benefit analysis.
Applies Medical Evidence to Decision Making for
Patients on Individual Basis
Demonstrate the ability to determine appropriateness
of clinical evidence for an individual patient.
Page 4 of 8
*
12
Assessment Tools
Direct observation
12
36
Research project design and

evaluation
36
*
24
Assessment Tools
Direct observation
Communicate risks and benefits of alternative

interventions to patients and families.
36
Integrate clinical evidence and family preferences into

36
Asks Appropriate Questions for Emerging Information

Needs
Identify learning needs (clinical questions) as they
emerge in patient care areas.
Clearly and precisely articulate clinical questions
Track, pursue, and reflect on clinical questions in a
systematic manner.
Incorporates Feedback Positively
Respond productively to feedback from all members of
the health care team.
Actively seek feedback from all members of the health
care team.
Capably develop plans for improvement using
formative feedback.
Improves via Self-Assessment
Maintain self awareness in clinical situations in real
time and adapts to situational needs.
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.
Participates in the Education of the Entire Health Care
Team
Actively participate in teaching conferences.
Conference evaluation
Clinical vignettes
Assessment Tools
12
Clinical vignettes
24
36
Direct observation
*
12
Assessment Tools
12
Self assessment tool
24
Mentored self reflection
*
24
Assessment Tools
36
Self assessment tool

*
3
Assessment Tools

Establish expectations and provide feedback when
supervising interns and/or medical students
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.
Participates in Quality Improvement
Appreciate the responsibility a physician has to assess
and improve care for his/her patients.
Actively participate in advocacy project.
Design and/or implement a quality improvement
project.
Attend a hospital quality improvement committee
meeting and reflect on the process at that level.
Page 5 of 8
24
30
Direct observation
Teaching evaluations
*
12
Assessment Tools
Direct observation
12
24 36
36
Self reflection
*
12
Assessment Tools
12
24
Direct observation
Quality project review
IV. INTERPERSONAL AND COMMUNICATION SKILLS

Communicate Effectively
Consistently and reliably provide timely and effective
communication with families and patients.
Effectively create rapport with patients and families.
Build effective therapeutic relationships with patients
and families.
Engage families and, where appropriate, patients in
clinical decision making when straightforward.
Effectively teach patients and families about specific
disease processes and provide appropriate discharge
education and anticipatory guidance.
Engage families and, where appropriate, patients in
clinical decision making when those decisions are
ambiguous, difficult, or controversial.
Counsel families about risks and benefits of tests and
procedures, and therapeutic options, including cost
awareness and resource requirements.
Role model effective communication in challenging
situations.
Intercultural Sensitivity
Effectively use interpreter services in the clinical
setting including patient education.
Demonstrate sensitivity to differences in patients
including, but not limited to, race, culture, gender,
sexual orientation, literacy, socioeconomic status, and
religion.
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.
24
24
36
36
36
*
6
Assessment Tools
12
30

Transitions of Care
Effectively communicate with other care providers to
maintain appropriate continuity during transitions of
care.
Role model effective communication with next care
provider team during transitions of patient care.
Interprofessional Team
Deliver appropriate, succinct, hypothesis driven oral
presentations.
Effectively communicate the plan of care to the entire
health care team and the patients family.
Engage in collaborative communication with all the
members of the health care team.
Consultation
Request consultative services in an effective manner.
Clearly communicate the role of the consultant to the
patients family, maintaining the primary service
relationship.
Communicate consultative recommendations to the
primary care team effectively.
Health Records
Consistently and reliably maintain accurate, complete
and legible records in a timely manner congruent with
medical records requirements and standards.
Ensure succinct, relevant, patient specific written
communication.
Page 6 of 8
*
12
Assessment Tools
Direct observation
24
Signout feedback
Assessment Tools
12
Direct observation
18
*
6
12
Assessment Tools
Chart audit
24
*
6
Assessment Tools
Chart audit
24
V. PROFESSIONALISM
Demonstrate Personal Accountability
Consistently and reliably dress and behave
professionally
Consistently and reliably maintain appropriate
professional relationships with patients, families, staff,
and colleagues.
Consistently and reliably promptly complete clinical,
administrative, and educational assignments.
Recognize personal limitations that may affect
professional performance, and address them.
Recognize professional limitations and request
assistance or supervision appropriately.
Recognize the need to assist colleagues and do so.
Respond promptly and appropriately to clinical
responsibilities including but not limited to calls and
pages.
Demonstrate Adherence to Basic Ethical Principles
Assessment Tools
Direct observation
6
6
6
6
6
Assessment Tools

Consistently and reliably document and report clinical
information truthfully.
Consistently and reliably accept personal errors and
honestly acknowledge them.
Adhere consistently to hospital policies.
Demonstrate empathy and compassion to all patients.
Treat patients and families with dignity, civility, and
respect regardless of race, age, gender, culture,
ethnicity, or socioeconomic status.
Consistently and reliably demonstrate a commitment
to relieve pain and suffering.
Provide support (physical, psychological, social, and
spiritual) for dying patients and their families.
Uphold ethical expectations of research and scholarly
activities.
Function in a Health Care Team as a Member or
Leader
Communicate constructive feedback to members of
the health care team.
Recognize and respond to impairment in colleagues or
to substandard care via peer review.
Lead the healthcare team where patient dignity and
autonomy is paramount in importance.
Practice Advocacy for Patients
Maintain patient confidentiality and educate others to
do the same.
Recognize when it is necessary to advocate for
individual patient needs.
Effectively advocate for individual patient needs.
Recognize that disparities exist in health care among
populations and that they may impact patient care.
Embrace the physicians role in assisting the public and
the policy makers in understanding health disparities.
Page 7 of 8
0
Direct observation
0
0
0
3
12
24
*
12
Assessment Tools
18
24
Assessment Tools
Direct observation
12
12
24
VI. SYSTEMS-BASED PRACTICE
Works Effectively Within the Complex Health Delivery

System
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.
Negotiate patient centered care among multiple
providers.
*
6
Assessment Tools
6
18

Manages care across the health care continuum:
ambulatory, inpatient services, skilled nursing facilities,
etc.
Coordinates the skill and activities of all members of
the health care team to optimize patient care.
Recognizes System Error and Advocates for System
Improvement
Identify, reflect on, and learn from critical incidents.
Recognizes issues in the health care system that
increase the risk for error including barriers to optimal
patient care.
Demonstrate an understanding for analysis of system
errors and participate in a system-level qualityimprovement intervention.
Advocates and Practices Cost Effective Care
Identify costs for common diagnostic or therapeutic
tests.
Reflect awareness of common economic barriers that
impact patient care.
Demonstrate an understanding of cost benefit analysis
as applied to patient care.
Integrate cost awareness and cost benefit analysis into
Page 8 of 8
36
36
*
12
36
Assessment Tools
Quality improvement project
evaluation
36
Assessment Tools
Direct observation
12
Standardized tests
12
36

Developmental Milestones Pediatrics

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Stanford Pediatrics Residency Program

Developmental Milestones in Pediatrics

Stanford Pediatrics Residency Program

II. MEDICAL KNOWLEDGE

Stanford Pediatrics Residency Program

III. PRACTICE-BASED LEARNING AND IMPROVEMENT

Search effectively and efficiently for original clinical

Appraise the quality of medical information resources

Stanford Pediatrics Residency Program

Research project design and

Communicate risks and benefits of alternative

Integrate clinical evidence and family preferences into

Asks Appropriate Questions for Emerging Information

Self assessment tool

Mentored self reflection

Self assessment tool

Stanford Pediatrics Residency Program

Quality project review

IV. INTERPERSONAL AND COMMUNICATION SKILLS

Mentored self reflection

Stanford Pediatrics Residency Program

Stanford Pediatrics Residency Program

Mentored self reflection

VI. SYSTEMS-BASED PRACTICE

Works Effectively Within the Complex Health Delivery

Stanford Pediatrics Residency Program

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