FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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`Exhibit P
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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`The Pediatrics Milestone Project
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`A Joint Initiative of
`The Accreditation Council for Graduate Medical Education
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`The American Board of Pediatrics
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`July 2017
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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`The Pediatrics Milestone Project
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`The Milestones are designed only for use in evaluation of resident physicians in the context of their participation in ACGME
`accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of
`the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither
`represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in
`any other context.
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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` Advisory Group
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`Pediatrics Milestones
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
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` Working Group
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`Chair: Carol Carraccio, MD, MA
`Bradley Benson, MD
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`Ann Burke, MD
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`Robert Englander, MD, MPH
`Susan Guralnick, MD
` Patricia Hicks, MD, MHPE
` Stephen Ludwig, MD
` Daniel Schumacher, MD
` Jerry Vasilias, PhD
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`Carol Aschenbrener, MD
`Richard Behrman, MD
`Timothy Brigham, MDiv, PhD
`Stephen Clyman, MD
`Eric Holmboe, MD
`M. Douglas Jones Jr., MD
`Gail McGuinness, MD
`Victoria Norwood, MD
`Robert Perelman, MD
`William Raszka, MD
`Theodore Sectish, MD
`Susan Swing, PhD
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`ii
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
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`Milestone Reporting
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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` A
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`This document presents milestones designed for programs to use in semi-annual review of resident performance and reporting to the ACGME.
`Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework
`from less to more advanced. The pediatrics milestones are designed to describe changes in observable attributes of the learner across the
`continuum of medical education from medical school through residency into practice. In the initial years of implementation, the Review
`Committee will examine milestone performance data for each program’s residents as one element in the Next Accreditation System (NAS) to
`determine whether residents overall are progressing.
`
`For each reporting period, review and reporting will involve selecting the level of milestones that best describes each resident’s current
`performance level in relation to milestones. Milestones are arranged into levels (See the figure on page iv). Progressing from Level 1 to Level 5
`is synonymous with moving from novice to expert. Selection of a level implies that the resident substantially demonstrates the milestones in
`that level, as well as those in lower levels.
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`
`Additional Notes
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`Level 3 is designed as the graduation target but does not represent a graduation requirement. Making decisions about readiness for graduation
`is the purview of the residency program director (See the Milestones FAQ for further discussion of this issue: “Can a resident/fellow graduate if
`he or she does not reach every milestone?”). Study of Milestone performance data will be required before the ACGME and its partners will be
`able to determine whether Level 3 milestones and milestones in lower levels are in the appropriate level within the developmental framework,
`and whether Milestone data are of sufficient quality to be used for high stakes decisions.
`
`Answers to Frequently Asked Questions about the Milestones are available on the Milestones web page:
`http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.
`
` full report on the Pediatrics Milestone Project, including background information on each set of Milestones, is located at
`http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/320_PedsMilestonesProject.pdf.
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`iii
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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`The figure below presents an example set of milestones for one sub-competency in the same format as the milestone report worksheet. For
`each reporting period, a resident’s performance on the milestones for each sub-competency will be indicated by:
`• selecting the level of milestones that best describes that resident’s performance in relation to the milestones
`or
`• selecting the “Not yet Assessable” response option. This option should be used only when a resident has not yet had a learning
`experience in the sub-competency.
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`Selecting a response box in the middle of a
`level implies that milestones in that level and
`in lower levels have been substantially
`demonstrated.
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`Selecting a response box on the line in between levels
`indicates that milestones in lower levels have been
`substantially demonstrated as well as some milestones
`in the higher level(s).
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`iv
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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`
`PEDIATRICS MILESTONES
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`ACGME Report Worksheet
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`Level 5
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`Creates robust illness
`scripts and instance scripts
`(where the specific
`features of individual
`patients are remembered
`and used in future clinical
`reasoning) that lead to
`unconscious gathering of
`essential and accurate
`information in a targeted
`and efficient manner when
`presented with all but the
`most complex or rare
`clinical problems. These
`illness and instance scripts
`are robust enough to
`enable discrimination
`among diagnoses with
`subtle distinguishing
`features
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`PC1. Gather essential and accurate information about the patient
`
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`Not yet
`Assessable
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`Level 1
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`Either gathers too little
`information or exhaustively
`gathers information following a
`template regardless of the
`patient’s chief complaint, with
`each piece of information
`gathered seeming as important
`as the next. Recalls clinical
`information in the order
`elicited, with the ability to
`gather, filter, prioritize, and
`connect pieces of information
`being limited by and
`dependent upon analytic
`reasoning through basic
`pathophysiology alone
`
`
`Level 2
`
`Clinical experience allows
`linkage of signs and
`symptoms of a current
`patient to those
`encountered in previous
`patients. Still relies
`primarily on analytic
`reasoning through basic
`pathophysiology to gather
`information, but has the
`ability to link current
`findings to prior clinical
`encounters allows
`information to be filtered,
`prioritized, and
`synthesized into pertinent
`positives and negatives, as
`well as broad diagnostic
`categories
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`
`Level 3
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`Demonstrates an advanced
`development of pattern
`recognition that leads to
`the creation of illness
`scripts, which allow
`information to be gathered
`while simultaneously
`filtered, prioritized, and
`synthesized into specific
`diagnostic considerations.
`Data gathering is driven by
`real-time development of a
`differential diagnosis early
`in the information-
`gathering process
`
`
`Level 4
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`Creates well-developed
`illness scripts that allow
`essential and accurate
`information to be gathered
`and precise diagnoses to
`be reached with ease and
`efficiency when presented
`with most pediatric
`problems, but still relies on
`analytic reasoning through
`basic pathophysiology to
`gather information when
`presented with complex or
`uncommon problems
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`Comments:
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`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`
`INDEX NO. 516861/2019
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`RECEIVED NYSCEF: 10/30/2019
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`PC2. Organize and prioritize responsibilities to provide patient care that is safe, effective, and efficient
`
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`Not yet
`Assessable
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`Level 1
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`Struggles to organize patient
`care responsibilities, leading to
`focusing care on individual
`patients rather than multiple
`patients; responsibilities are
`prioritized as a reaction to
`unanticipated needs that arise
`(those responsibilities
`presenting the most significant
`crisis at the time are given the
`highest priority); even small
`interruptions in task often lead
`to a prolonged or permanent
`break in that task to attend to
`the interruption, making return
`to initial task difficult or
`unlikely
`
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`Level 2
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`Level 3
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`Organizes the
`simultaneous care of a few
`patients with efficiency;
`occasionally prioritizes
`patient care
`responsibilities to
`anticipate future needs;
`each additional patient or
`interruption in work leads
`to notable decreases in
`efficiency and ability to
`effectively prioritize;
`permanent breaks in task
`with interruptions are less
`common, but prolonged
`breaks in task are still
`common
`
`Organizes the
`simultaneous care of many
`patients with efficiency;
`routinely prioritizes patient
`care responsibilities to
`proactively anticipate
`future needs; additional
`care responsibilities lead to
`decreases in efficiency and
`ability to effectively
`prioritize only when
`patient volume is quite
`large or there is a
`perception of competing
`priorities; interruptions in
`task are prioritized and
`only lead to prolonged
`breaks in task when
`workload or cognitive load
`is high
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`Level 4
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`Organizes patient care
`responsibilities to optimize
`efficiency; provides care to
`a large volume of patients
`with marked efficiency;
`patient care
`responsibilities are
`prioritized to proactively
`prevent those urgent and
`emergent issues in patient
`care that can be
`anticipated; interruptions
`in task lead to only brief
`breaks in task in most
`situations
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`Level 5
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`Serves as a role model of
`efficiency; patient care
`responsibilities are
`prioritized to proactively
`prevent interruption by
`routine aspects of patient
`care that can be
`anticipated; unavoidable
`interruptions are
`prioritized to maximize
`safe and effective
`multitasking of
`responsibilities in
`essentially all situations
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`Comments:
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`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`PC3. Provide transfer of care that ensures seamless transitions
`
`
`Not yet
`Assessable
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`Level 1
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`Demonstrates variability in
`transfer of information
`(content, accuracy, efficiency,
`and synthesis) from one patient
`to the next; makes frequent
`errors of both omission and
`commission in the hand-off
`
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`Level 2
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`Uses a standard template
`for the information
`provided during the hand-
`off; is unable to deviate
`from that template to
`adapt to more complex
`situations; may have errors
`of omission or commission,
`particularly when clinical
`information is not
`synthesized; neither
`anticipates nor attends to
`the needs of the receiver
`of information
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`Level 3
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`Adapts and applies a
`standardized template,
`relevant to individual
`contexts, reliably and
`reproducibly, with minimal
`errors of omission or
`commission; allows ample
`opportunity for
`clarification and questions;
`is beginning to anticipate
`potential issues for the
`transferee
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`
`Level 4
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`Adapts and applies a
`standard template to
`increasingly complex
`situations in a broad
`variety of settings and
`disciplines; ensures open
`communication, whether
`in the receiver- or the
`provider-of-information
`role, through deliberative
`inquiry, including read-
`backs, repeat-backs
`(provider), and clarifying
`questions (receivers)
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`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
`
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`Level 5
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`Adapts and applies the
`template without error
`and regardless of setting or
`complexity; internalizes
`the professional
`responsibility aspect of
`hand-off communication,
`as evidenced by formal and
`explicit sharing of the
`conditions of transfer (e.g.,
`time and place) and
`communication of those
`conditions to patients,
`families, and other
`members of the health
`care team
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`Comments:
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`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`
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`PC4. Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment
`
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`Not yet
`Assessable
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`Level 1
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`Recalls and presents clinical
`facts in the history and physical
`in the order they were elicited
`without filtering,
`reorganization, or synthesis;
`demonstrates analytic
`reasoning through basic
`pathophysiology results in a list
`of all diagnoses considered
`rather than the development of
`working diagnostic
`considerations, making it
`difficult to develop a
`therapeutic plan
`
`
`Level 2
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`Level 3
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`Focuses on features of the
`clinical presentation,
`making a unifying diagnosis
`elusive and leading to a
`continual search for new
`diagnostic possibilities;
`largely uses analytic
`reasoning through basic
`pathophysiology in
`diagnostic and therapeutic
`reasoning; often
`reorganizes clinical facts in
`the history and physical
`examination to help decide
`on clarifying tests to order
`rather than to develop and
`prioritize a differential
`diagnosis, often resulting
`in a myriad of tests and
`therapies and unclear
`management plans, since
`there is no unifying
`diagnosis
`
`Abstracts and reorganizes
`elicited clinical findings in
`memory, using semantic
`qualifiers (such as paired
`opposites that are used to
`describe clinical
`information [e.g., acute
`and chronic]) to compare
`and contrast the diagnoses
`being considered when
`presenting or discussing a
`case; shows the
`emergence of pattern
`recognition in diagnostic
`and therapeutic reasoning
`that often results in a well-
`synthesized and organized
`assessment of the focused
`differential diagnosis and
`management plan
`
`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
`
`
`Level 4
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`Reorganizes and stores
`clinical information (illness
`and instance scripts) that
`lead to early directed
`diagnostic hypothesis
`testing with subsequent
`history, physical
`examination, and tests
`used to confirm this initial
`schema; demonstrates
`well-established pattern
`recognition that leads to
`the ability to identify
`discriminating features
`between similar patients
`and to avoid premature
`closure; Selects therapies
`that are focused and based
`on a unifying diagnosis,
`resulting in an effective
`and efficient diagnostic
`work-up and management
`plan tailored to address
`the individual patient
`
`
`
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`Level 5
`
`Current literature does
`not distinguish between
`behaviors of proficient
`and expert practitioners.
`Expertise is not an
`expectation of GME
`training, as it requires
`deliberate practice over
`time
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`Comments:
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`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`PC5. Develop and carry out management plans
`
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`Not yet
`Assessable
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`
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`Level 1
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`Develops and carries out
`management plans based on
`directives from others, either
`from the health care
`organization or the supervising
`physician; is unable to adjust
`plans based on individual
`patient differences or
`preferences; communication
`about the plan is unidirectional
`from the practitioner to the
`patient and family
`
`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
`
`
`Level 4
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`Develops and carries out
`management plans based
`most often on experience;
`effectively and efficiently
`focuses on key information
`to arrive at a plan;
`incorporates patients’
`assumptions and values
`through bidirectional
`communication with little
`interference from personal
`biases
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`
`Level 5
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`Develops and carries out
`management plans, even
`for complicated or rare
`situations, based primarily
`on experience that puts
`theoretical knowledge into
`context; rapidly focuses on
`key information to arrive
`at the plan and augments
`that with available
`information or seeks new
`information as needed; has
`insight into one’s own
`assumptions and values
`that allow one to filter
`them out and focus on the
`patient/family values in a
`bidirectional conversation
`about the management
`plan
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`Level 2
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`Level 3
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`Develops and carries out
`management plans based
`on one’s theoretical
`knowledge and/or
`directives from others; can
`adapt plans to the
`individual patient, but only
`within the framework of
`one’s own theoretical
`knowledge; is unable to
`focus on key information,
`so conclusions are often
`from arbitrary, poorly
`prioritized, and time-
`limited information
`gathering; develops
`management plans based
`on the framework of one’s
`own assumptions and
`values
`
`Develops and carries out
`management plans based
`on both theoretical
`knowledge and some
`experience, especially in
`managing common
`problems; follows health
`care institution directives
`as a matter of habit and
`good practice rather than
`as an externally imposed
`sanction; is able to more
`effectively and efficiently
`focus on key information,
`but still may be limited by
`time and convenience;
`begins to incorporate
`patients’ assumptions and
`values into plans through
`more bidirectional
`communication
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`Comments:
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`
`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
`
`
`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
`
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`MK1. Critically evaluate and apply current medical information and scientific evidence for patient care
`
`
`Not yet
`Assessable
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`
`
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`Level 1
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`Explains basic principles of
`Evidence-based Medicine
`(EBM), but relevance is limited
`by lack of clinical exposure
`
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`
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`Level 2
`
`
`Level 3
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`Recognizes the importance
`of using current
`information to care for
`patients and responds to
`external prompts to do so;
`is able to formulate
`questions with significant
`effort and time; online
`search efficiency is
`minimal; (e.g., may require
`multiple search strategies);
`knows how to read and
`interpret the literature but
`requires guidance for
`application
`
`
`Identifies knowledge gaps
`as learning opportunities;
`makes an effort to ask
`answerable questions on a
`regular basis and is
`becoming increasingly able
`to do so; understands
`varying levels of evidence
`and can utilize advanced
`search methods; is able to
`critically appraise a topic
`by analyzing the major
`outcomes, however, may
`need guidance in
`understanding the
`subtleties of the evidence;
`begins to seek and apply
`evidence when needed,
`not just when assigned to
`do so
`
`
`Level 4
`
`Formulates answerable
`clinical questions regularly;
`incorporates use of clinical
`evidence in rounds and
`teaches fellow learners; is
`quite capable with
`advanced searching; is able
`to critically appraise topics
`and does so regularly;
`shares findings with others
`to try to improve their
`abilities; practices EBM
`because of the benefit to
`the patient and the desire
`to learn more rather than
`in response to external
`prompts
`
`
`Level 5
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`Teaches critical appraisal
`of topics to others; strives
`for change at the
`organizational level as
`dictated by best current
`information; is able to
`easily formulate
`answerable clinical
`questions and does so with
`majority of patients as a
`habit; is able to effectively
`and efficiently search and
`access the literature; is
`seen by others as a role
`model for practicing EBM
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`Comments:
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`
`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
`
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`SBP1. Coordinate patient care within the health care system relevant to their clinical specialty
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`Not yet
`Assessable
`
`
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`Level 1
`
`Performs the role of medical
`decision-maker, developing
`care plans and setting goals of
`care independently; informs
`patient/family of the plan, but
`no written care plan is
`provided; makes referrals, and
`requests consultations and
`testing with little or no
`communication with team
`members or consultants; is not
`involved in the transition of
`care between settings (e.g.,
`outpatient and inpatient,
`pediatric and adult); shows
`little or no recognition of
`social/educational/cultural
`issues affecting the
`patient/family
`
`
`Level 2
`
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`Level 3
`
`Begins to involve the
`patient/family in setting
`care goals and some of the
`decisions involved in the
`care plan; a written care
`plan is occasionally made
`available to the
`patient/family; care plan
`does not address key
`issues; has variable
`communication with team
`members and consultants
`regarding referrals,
`consultations, and testing;
`answers patient/family
`questions regarding results
`and recommendations;
`may inconsistently be
`involved in the transition
`of care between settings
`(e.g., outpatient and
`inpatient, pediatric and
`adult); makes some
`assessment of
`social/educational/cultural
`issues affecting the
`patient/family and applies
`this in interactions
`
`Recognizes the
`responsibility to assist
`families in navigation of
`the complex health care
`system; frequently involves
`patient/family in decisions
`at all levels of care, setting
`goals, and defining care
`plans; frequently makes a
`written care plan available
`to the patient/family and
`to appropriately
`authorized members of the
`care team; care plan omits
`few key issues; has good
`communication with team
`members and consultants;
`consistently discusses
`results and
`recommendations with
`patient/family; is routinely
`involved in the transition
`of care between settings
`(e.g., outpatient and
`inpatient, pediatric and
`adult); considers social,
`educational and cultural
`issues in most care
`interactions
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`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
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`Level 5
`
`Current literature does
`not distinguish between
`behaviors of proficient
`and expert practitioners.
`Expertise is not an
`expectation of GME
`training, as it requires
`deliberate practice over
`time
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`Level 4
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`Actively assists families in
`navigating the complex
`health care system; has
`open communication,
`facilitating trust in the
`patient-physician
`interaction; develops goals
`and makes decisions jointly
`with the patient/family
`(shared-decision-making);
`routinely makes a written
`care plan available to the
`patient/family and to
`appropriately authorized
`members of the care team;
`makes a thorough care
`plan, addressing all key
`issues; facilitates care
`through consultation,
`referral, testing,
`monitoring, and follow-up,
`helping the family to
`interpret and act on
`results/recommendations;
`coordinates seamless
`transitions of care
`between settings (e.g.,
`outpatient and inpatient,
`pediatric and adult; mental
`and dental health;
`education; housing; food
`security; family-to-family
`
`
`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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` 7
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`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
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`support); builds
`partnerships that foster
`family-centered, culturally-
`effective care, ensuring
`communication and
`collaboration along the
`continuum of care
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
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`Comments:
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`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
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` 8
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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
`
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`SBP2. Advocate for quality patient care and optimal patient care systems
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`
`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
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`Level 4
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`Actively participates in
`hospital-initiated quality
`improvement and safety
`actions; demonstrates a
`desire to have an impact
`beyond the hospital walls
`
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`
`
`Example:
`The physician attends a
`hospital symposium on
`gun-related trauma and
`what can be done about it
`and then arranges to speak
`on gun safety at the local
`meeting of the parent-
`teachers association.
`
`
`Level 5
`
`Identifies and acts to begin
`the process of
`improvement projects
`both inside the hospital
`and within one’s practice
`community
`
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`
`
`Example:
`Upon completion of quality
`improvement project, the
`physician works on new
`proposed legislation and
`testifies in City Council.
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`Not yet
`Assessable
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`Level 1
`
`Attends to medical needs of
`individual patient(s); wants to
`take good care of patients and
`takes action for individual
`patients’ health care needs
`
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`Example:
`Sees a child with a firearm
`injury and provides good care.
`
`
`Level 2
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`Level 3
`
`Demonstrates recognition
`that an individual patient’s
`issues are shared by other
`patients, that there are
`systems at play, and that
`there is a need for quality
`improvement of those
`systems; acts on the
`observed need to assess
`and improve quality of
`care
`
`Example:
`A physician notes on
`rounds, “We have sent
`home four-to-five firearm-
`injury patients and one has
`come back with repeated
`injury. We need to do
`something about that.”
`
`Acts within the defined
`medical role to address an
`issue or problem that is
`confronting a cohort of
`patients; may enlist
`colleagues to help with this
`problem
`
`
`
`
`
`Example:
`The physician works with
`colleagues to develop an
`approach, protocol, or
`procedure for improving
`care for penetrating
`trauma injury in children
`and measures the
`outcomes of system
`changes.
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`Comments:
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`
`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
`
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` 9
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`

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`SBP3. Work in inter-professional teams to enhance patient safety and improve patient care quality
`
`
`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
`
`
`Not yet
`Assessable
`
`
`
`
`Level 1
`
`Seeks answers and responds to
`authority from only intra-
`professional colleagues; does
`not recognize other members
`of the interdisciplinary team as
`being important or making
`significant contributions to the
`team; tends to dismiss input
`from other professionals aside
`from other physicians
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`Comments:
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`
`INDEX NO. 516861/2019
`
`RECEIVED NYSCEF: 10/30/2019
`
`
`
`Level 5
`
`Current literature does
`not distinguish between
`behaviors of proficient
`and expert practitioners.
`Expertise is not an
`expectation of GME
`training, as it requires
`deliberate practice over
`time
`
`
`
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`Level 4
`
`Same as Level 3, but an
`individual at this stage
`understands the broader
`connectivity of the
`professions and their
`complementary nature;
`recognizes that quality
`patient care only occurs in
`the context of the inter-
`professional team; serves
`as a role model for others
`in interdisciplinary work
`and is an excellent team
`leader
`
`
`Level 2
`
`
`Level 3
`
`Aware of the unique
`contributions (knowledge,
`skills, and attitudes) of
`other health care
`professionals, and seeks
`their input for appropriate
`issues, and as a result, is an
`excellent team player
`
`Is beginning to have an
`understanding of the other
`professionals on the team,
`especially their unique
`knowledge base, and is
`open to their input,
`however, still acquiesces to
`physician authorities to
`resolve conflict and
`provide answers in the
`face of ambiguity; is not
`dismissive of other health
`care professionals, but is
`unlikely to seek out those
`individuals when
`confronted with
`ambiguous situations
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`
`Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Pediatrics. All rights reserved. The copyright owners grant third
`parties the right to use the Pediatrics Milestones on a non-exclusive basis for educational purposes.
`
`
`
`
`
`
`
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`
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`
` 10
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`

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`FILED: KINGS COUNTY CLERK 10/30/2019 07:42 PM
`NYSCEF DOC. NO. 45
`Version 7/2017
`
`
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`PBLI1. Identify strengths, deficiencies, and limits in one’s knowledge and expertise
`
`
`Not yet
`Assessable
`
`
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`
`
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`Level 1
`
`The learner acknowledges
`external assessments, but
`understanding of his
`performance is superficial and
`limited to the overall grade or
`bottom line; has little
`understanding of how the
`performance measure relates
`in a meaningful way to his
`specific level of Knowledge,
`Skills and Attitudes (KSA)
`
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`
`Example:
`During a semiannual review, a
`learner is unable to describe in
`any specific terms how he has
`performed when asked to do so
`by his mentor. In response, the
`mentor reviews and interprets
`the learner’s evaluations and
`then asks the learner to reflect
`on the discussion. The learner
`repeats the language used and
`recites the overall score/grade
`
`
`Level 2
`
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`Level 3
`
`Assessment of
`performance is seen as
`being able to do or not do
`the task at hand without
`appreciation for how well
`it is done and whether
`there is a need to improve
`the outcome
`
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`Prompts for understanding
`specifics of level of
`performance are internal
`and may be identified in
`response to uncertainty,
`discomfort, or tension in
`completing clinical duties;
`evidence of this stage is
`demonstrated by active
`questioning and
`application of knowledge
`in developing a rationale
`for care plans or in
`teaching activities
`
`
`
`Example:
`The learner seeks external
`assessment of performance
`as ability “to do” or “not
`able to do” with little
`understanding of what the
`assessment means. “Are
`these orders written
`correctly?” “Did I do that
`correctly?” Seeks feedback
`approval on whether KSA
`were “right” or “wrong.”
`
`
`Example:
`Learner requests
`elaboration, clarification,
`or expansion on patient-
`care related task. “Why
`would we use this
`ant