Putting the pediatrics milestones into practice: a consensus roadmap and resource analysis.

The Accreditation Council for Graduate Medical Education has partnered with member boards of the American Board of Medical Specialties to initiate the next steps in advancing competency-based assessment in residency programs. This initiative, known as the Milestone Project, is a paradigm shift from traditional assessment efforts and requires all pediatrics residency programs to report individual resident progression along a series of 4 to 5 developmental levels of performance, or milestones, for individual competencies every 6 months beginning in June 2014. The effort required to successfully make this shift is tremendous given the number of training programs, training institutions, and trainees.

Extra-immunization as a clinical indicator for fragmentation of care.

Objectives: We assessed whether extra-immunization can serve as a clinical indicator for fragmentation of care.

Methods: Using public-use files of the 1999-2003 National Immunization Survey, we classified children 19-35 months of age by their vaccination providers for the degree of fragmentation of care as ordered from lowest with one vaccine provider, to increasing fragmentation with multiple providers in one facility type, to multiple providers in more than one facility type. Extra-immunization was defined conservatively based on the year-specific recommendations of the Advisory Committee on Immunization Practices (ACIP) for immunizations due before 18 months of age.

Effect of 80-hour workweek on continuity of care.

Work limitations were mandated (2003) to increase safety and improve resident lifestyle. Is clinic continuity affected? Medical University of South Carolina pediatric residents' records for 6 months of 2002 (before regulation) and 2003 (after regulation) were reviewed. Continuity for physician formula, t tests, and multivariate linear regression were used.