Pediatric Surgery Milestones: The Accreditation Council For Graduate Medical Education

Pediatric Surgery Milestones
The Accreditation Council for Graduate Medical Education
Implementation: July 2022

Second Revision: August 2021
First Revision: January 2014
©2021 Accreditation Council for Graduate Medical Education (ACGME)

All rights reserved except the copyright owners grant third parties the right to use the Pediatric Surgery Milestones on a non-exclusive basis for educational purposes.
The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGME-
accredited fellowship programs. The Milestones provide a framework for the assessment of the development of
the fellow in key dimensions of the elements of physician competence in a specialty or subspecialty. They
neither represent the entirety of the dimensions of the six domains of physician competence, nor are they
designed to be relevant in any other context.

2
Work Group
Samuel Alaish, MD Barbara Gaines, MD

Marjorie J. Arca, MD Cornelia Griggs, MD
Brian Bucher, MD Patrick Javid, MD
Cathi Cooney, C-TAGME Sanjay Krishnaswami, MD
Diana L. Diesen, MD William Middlesworth, MD
Laura Edgar, EdD, CAE Cynthia Wong, DMD, MS
Peter Ehrlich, MD, MSC
The ACGME would like to thank the following organizations for their continued support in the
development of the Milestones:
Pediatric Surgery Board, American Board of Surgery
Review Committee for Surgery

3
Understanding Milestone Levels and Reporting
This document presents the Milestones, which programs use in a semi-annual review of fellow performance, and then report to
the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME Competencies organized in a
developmental framework. The narrative descriptions are targets for fellow performance throughout their educational program.
Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert fellow in
the specialty or subspecialty. For each reporting period, the Clinical Competency Committee will review the completed evaluations
to select the milestone levels that best describe each learner’s current performance, abilities, and attributes for each
subcompetency.
These levels do not correspond with post-graduate year of education. Depending on previous experience, a junior fellow may
achieve higher levels early in the educational program just as a senior fellow may be at a lower level later in the educational
program. There is no predetermined timing for a fellow to attain any particular level. Fellows may also regress in achievement of
their milestones. This may happen for many reasons, such as over scoring in a previous review, a disjointed experience in a
particular procedure, or a significant act by the fellow.
Selection of a level implies the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see
the diagram on page v).

iv
Additional Notes
Level 4 is designed as a graduation goal but does not represent a graduation requirement. Making decisions about readiness for
graduation and unsupervised practice is the purview of the program director. Furthermore, Milestones 2.0 include revisions and
changes that preclude using Milestones as a sole assessment in high-stakes decisions (i.e., determination of eligibility for
certification or credentialing). Level 5 is designed to represent an expert fellow whose achievements in a subcompetency are
greater than the expectation. Milestones are primarily designed for formative, developmental purposes to support continuous
quality improvement for individual learners, education programs, and the specialty. The ACGME and its partners will continue to
evaluate and perform research on the Milestones to assess their impact and value.
Some milestone descriptions include statements about performing independently. These activities must occur in conformity to
ACGME supervision guidelines as described in the Program Requirements, as well as to institutional and program policies. For
example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight.
A Supplemental Guide is also available to provide the intent of each subcompetency, examples for each level, assessment
methods or tools, and other available resources. The Supplemental Guide, is designed only to assist the program director and
Clinical Competency Committee, and is not meant to demonstrate any required element or outcome.
Additional resources are available in the Milestones section of the ACGME website. Follow the links under “What We Do” at
www.acgme.org.

v
The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME
Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be
indicated by selecting the level of milestones that best describes that fellow’s performance in relation to those milestones.
Selecting a response box on the line in

Selecting a response box in the
between levels indicates that milestones
middle of a level implies that
in lower levels have been substantially
milestones in that level and in lower
demonstrated as well as some
levels have been substantially
milestones in the higher level(s).
demonstrated.

vi
Version 2 Pediatric Surgery, ACGME Report Worksheet
Patient Care 1: Patient Evaluation and Clinical Decision Making
Level 1 Level 2 Level 3 Level 4 Level 5

With assistance, With assistance, Independently integrates Independently Appraises gaps in
integrates information integrates information information with patient- integrates information literature and proposes
with patient-specific with patient-specific specific factors to design with patient-specific research related to
factors to design a factors to design a a succinct diagnostic, factors to design a diagnostic work-up and
succinct diagnostic, succinct diagnostic, work- work-up, and succinct diagnostic, multidisciplinary treatment
work-up, and up, and management plan management plan of a work-up, and
management plan of a of a medically medically uncomplicated management plan of a
medically uncomplicated complicated neonatal or neonatal or pediatric medically complicated
neonatal or pediatric pediatric surgical patient surgical patient neonatal or pediatric
surgical patient surgical patient
Comments:
Not Yet Completed Level 1
Not Yet Rotated

1
Patient Care 2: Intra-Operative Patient Care – Endoscopy Procedural Skills

Requires active direction Is mostly proficient in Is consistent able to Independently chooses Independently
to choose and assemble choosing and assembling choose and assemble and assembles troubleshoots
instruments instruments instruments for diagnostic instruments instrument
bronchoscopy and malfunction and failure
endoscopy
Moves forward in Moves forward in Independently moves Independently moves Independently moves
diagnostic bronchoscopy therapeutic or forward in diagnostic fluidly through therapeutic fluidly through the
and endoscopy only with interventional procedures bronchoscopy and or interventional course of rare
active direction with active direction endoscopy and refines procedures and refines operations and refines
operative plans as operative plans as operative plans as
needed needed needed
Recognizes intra- With active assistance, Independently Independently Anticipates and

operative complications manages intra-operative recognizes, manages, recognizes, manages, prevents intra-operative
for common procedures complications for anticipates, and prevents anticipates, and prevents complications for rare
therapeutic and straightforward intra- complex intra-operative procedures
interventional procedures operative complications complications
Comments:
Not Yet Rotated

2
Patient Care 3: Intra-Operative Patient Care – Procedural Skills for Minimally Invasive Surgical Procedures

Requires active direction Is mostly proficient in Is consistently able to Independently Independently
to identify trocar ability to identify trocar identify trocar placement identifies trocar troubleshoots instrument,
placement and placement and and appropriate MIS placement in patients camera, robotic failure,
appropriate appropriate MIS instrumentation for with abnormal and modified operative
instrumentation for instrumentation common and defined anatomy/re-operative approach
minimally invasive category procedures cases
surgery (MIS)
Moves forward in Moves forward through Independently (passive Independently (passive Independently (passive
common operations with the course of defined help or supervision only) help or supervision help or supervision only)
active direction only category operations with moves forward in only) moves forward in moves forward in rare
active direction common operations and defined category operations and refines
refines operative plans as operations and refines operative plans as needed
needed operative plans as
needed
Recognizes intra- With assistance, Independently Independently Anticipates and prevents

operative complications manages intra-operative recognizes, manages, recognizes, manages, intra-operative
for common procedures complications for defined anticipates, and prevents anticipates, and complications for rare
category procedures intra-operative prevents intra- procedures
complications for common operative
procedures complications for
defined category
procedures

Not Yet Rotated

3
Patient Care 4: Intra-Operative Patient Care – Procedural Skills for Thoracic Cases

Moves forward in Moves fluidly through the Independently (passive Independently (passive Independently (passive
common operations with entire course of common help or supervision only) help or supervision help or supervision only)
active direction for critical operations with minimal moves fluidly through the only) moves fluidly moves fluidly through the
portions of the procedure prompting course of common through the course of course of rare operations
operations and refines defined category and refines operative
operative plans as operations and refines plans as needed
needed
Serves as first assistant Requires active direction Moves fluidly through the Requires active
for critical portions of for defined category entire course of defined direction for critical
defined category operations category operations with portions of rare
operations minimal prompting operations
Recognizes intra- With assistance, Independently manages, Independently Independently

operative complications manages, anticipates, anticipates, and prevents recognizes, manages, recognizes, manages,
for common operations and prevents intra- intra-operative anticipates, and anticipates, and prevents
operative complications complications for common prevents intra-operative intra-operative
for common procedures procedures complications for complications for rare
defined category procedures
procedures
Comments:
Not Yet Rotated

4
Patient Care 5: Intra-Operative Patient Care – Procedural Skills for Abdominal Procedures

Moves forward in Moves fluidly through the Independently (passive Independently (passive Independently (passive
common operations with entire course of common help or supervision only) help or supervision help or supervision only)
active direction for operations with minimal moves fluidly through the only) moves fluidly moves fluidly through the
critical portions of the prompting course of common through the course of course of rare operations
procedure operations and refines defined category and refines operative
operative plans as operations and refines plans as needed
needed

procedures
Comments:
Not Yet Rotated

5
Patient Care 6: Intra-Operative Patient Care – Procedural Skills for Oncology Cases

Moves forward in Moves fluidly through Independently (passive Independently (passive Independently (passive
common operations with the entire course of help or supervision only) help or supervision help or supervision only)
active direction for common operations with moves fluidly through the only) moves fluidly moves fluidly through the
critical portions of the minimal prompting course of common through the course of course of rare operations
procedure operations and refines defined category and refines operative
operative plans as needed operations and refines plans as needed
operative plans as
needed

procedures
Comments:
Not Yet Rotated

6
Patient Care 7: Intra-Operative Patient Care – Procedural Skills for Other Operations

Moves forward in Moves fluidly through Independently (passive Independently (passive Independently (passive
common operations with the entire course of help or supervision only) help or supervision only) help or supervision only)
active direction for critical common operations with moves fluidly through the moves fluidly through the moves fluidly through
portions of the procedure minimal prompting course of common course of defined the course of rare
operations and refines category operations and operations and refines
operative plans as needed refines operative plans as operative plans as
needed needed
Serves as first assistant Requires active direction Moves fluidly through the Requires active direction
for critical portions of for defined category entire course of defined for critical portions of rare
defined category operations category operations with operations
operations minimal prompting

for common operations and prevents intra- intra-operative anticipates, and prevents anticipates, and
operative complications complications for common intra-operative prevents intra-operative
for common procedures procedures complications for defined complications for rare
category procedures procedures
Comments:
Not Yet Rotated

7
Patient Care 8: Tissue Handling of Delicate (oncologic, inflamed, and scarred tissue) and Neonatal Tissue

Demonstrates limited skill Demonstrates adequate Consistently Adapts tissue handling Demonstrates efficiency
in handling delicate and but inconsistent handling demonstrates careful based on tissue quality and instructs other
neonatal tissue of delicate and neonatal handling of delicate and learners in techniques
tissue neonatal tissue to identify and
manipulate delicate and
neonatal tissue in rare
procedures
Requires prompting to Identifies appropriate Visualizes tissue plane, Visualizes tissue planes Develops new
identify appropriate tissue plane but requires and identifies and dissects and identifies and instrumentation and
planes redirection to maintain relevant normal anatomy dissects relevant techniques for delicate
dissection in the optimal abnormal anatomy and neonatal tissue
tissue plane
Comments:
Not Yet Rotated

8
Patient Care 9: Post-Operative Care (Short- and Long-Term)

With assistance, Independently manages With minimal assistance, Independently manages Identifies gaps in post-
manages the post- the post-operative course manages the post- the post-operative operative management,
operative course of an of an uncomplicated operative course of a course of a complicated and creates pathways to
uncomplicated neonatal neonatal or pediatric complicated neonatal or neonatal or pediatric address these through
or pediatric surgical surgical patient pediatric surgical patient surgical patient quality
patient improvement/research
initiatives
Identifies the rationale Describes a general long- Follows an evidence Integrates patient- and Identifies knowledge gaps
for a long-term term management plan based long-term patient family-specific in long-term management
management management plan factors in the plans, and creates
construction of an pathways to address
evidence-based long- these through quality
term management plan improvement/research
initiatives
Comments:
Not Yet Rotated

9
Patient Care 10: Critical Care

With assistance, Independently recognizes With minimal assistance, Independently Implements novel
recognizes a critically ill a critically ill neonate or individualizes ongoing individualizes ongoing treatments and care
neonate or child and child and begins critical care management critical care pathways for critically ill
begins resuscitation resuscitation and initial and assesses the management and children
management response to therapy assesses the response
to therapy
Comments:
Not Yet Rotated

10
Patient Care 11: Trauma Management

With active direction, With minimal prompting, Independently provides Leads a Implements novel
provides non-operative provides non-operative non-operative multidisciplinary team in treatments and care
management of severely management of severely management of severely the ongoing pathways for injured
injured infants and injured infants and injured infants and management of children
children children children severely injured infants
and children
Recognizes injuries in With active direction, With minimal prompting, Independently provides
infants and children and provides operative provides operative operative management
provides initial operative management of severely management of severely of severely injured
management injured infants and injured infants and infants and children
children children
Comments:
Not Yet Rotated

11
Medical Knowledge 1: Anatomy

Demonstrates Demonstrates knowledge With assistance, identifies Independently identifies Leads advanced anatomy
knowledge of surgically of surgically relevant surgically relevant surgically relevant discussion at a
relevant normal anatomy anatomic variations anatomic variations and anatomic variations and multidisciplinary
alters patient alters patient conference and/or in
management accordingly management operating room
accordingly
Comments:
Not Yet Rotated

12
Medical Knowledge 2: Developmental Biology and Neonatal Physiology

Demonstrates basic Demonstrates With assistance, applies Independently Recommends novel
knowledge of comprehensive knowledge of incorporates knowledge investigations based on
developmental biology knowledge of developmental biology of developmental knowledge of
and normal neonatal developmental biology and neonatal physiology biology and neonatal developmental biology,
physiology and neonatal physiology into medical decision physiology into medical neonatal physiology, and
and relevant clinical making decision making new and existing
implications therapies
Comments:
Not Yet Assessable

13
Medical Knowledge 3: Pediatrics and Pediatrics Surgery

Demonstrates Demonstrates knowledge Demonstrates basic Demonstrates Contributes to peer-
knowledge of of pathophysiology and knowledge of advanced knowledge of reviewed literature on the
development and treatments of patients pathophysiology and the varying patterns of varying patterns of
physiology of children with common pediatric treatments of patients disease presentation disease presentation, and
conditions with complex pediatric and treatment at age-appropriate
conditions different ages for treatments of patients
patients with pediatric with pediatric conditions
conditions
Demonstrates knowledge Demonstrates basic Demonstrates Contributes to peer-

of pathophysiology and knowledge of comprehensive reviewed literature on the
treatments of patients pathophysiology and knowledge of the varying patterns of
with common pediatric treatments of patients varying patterns of disease presentation, and
surgical conditions with complex pediatric disease presentation age-appropriate
surgical conditions and treatment at treatments of patients
different ages for with pediatric surgical
patients with pediatric conditions
surgical conditions
Comments:
Not Yet Assessable

14
Systems-Based Practice 1: Patient Safety and Quality Improvement

Demonstrates Reports patient safety Participates in disclosure Independently Role models or mentors
knowledge of how to events through of patient safety events to (supervision only) others in the disclosure of
report patient safety institutional reporting patients and patients’ discloses patient safety patient safety events
events systems (simulated or families (simulated or events to patients and
actual) actual) patients’ families
(simulated or actual)
Demonstrates Participates in institutional Demonstrates the skills Creates, implements, Creates, implements, and
knowledge of and quality improvement required to identify, and assesses quality assesses national quality
describes institutional initiatives develop, implement, and improvement initiatives improvement initiatives
quality improvement analyze an institutional at the institutional level
initiatives quality improvement
project
Comments:

15
Systems-Based Practice 2: System Navigation for Patient-Centered Care

Demonstrates Coordinates care of Coordinates care of Role models effective Analyzes the process of
knowledge of care patients in routine clinical patients in complex coordination of patient- care coordination and
coordination, including situations effectively using clinical situations centered care among leads in the design and
transitions of care the roles of the effectively using the roles different disciplines, implementation of
interprofessional teams, of their interprofessional including transitions of improvements, including
including transitions of teams, including care transitions of care
care transitions of care
Demonstrates Identifies specific Coordinates with local Participates in changing Leads innovations and
knowledge of the population health needs resources to effectively and adapting individual advocates for pediatric
pediatric surgical and inequities for their meet the needs of a practice to provide for surgical populations with
population health needs local pediatric surgical pediatric surgical patient the needs of specific health care inequities
and disparities population population pediatric surgical
populations
Comments:

16
Systems-Based Practice 3: Physician Role in Health Care Systems

Identifies key Describes how Discusses how individual Manages various Advocates for or leads
components of the components of a complex practice affects the components of the systems change that
complex health care health care system are broader system (e.g., complex health care enhances high-value,
system (e.g., hospital, interrelated, and how this length of stay, system to provide efficient, and effective
pediatric rehabilitation impacts pediatric surgical readmission rates, clinical efficient and effective patient care and transition
facility, finance, patient care efficiency) patient care and of care for the pediatric
personnel, technology, transition of care surgical population
payment systems)
Comments:

17
Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice

Demonstrates how to Articulates clinical Locates and applies the Critically appraises and Coaches others to
access and use the questions and elicits the best available evidence, applies evidence, even critically appraise and
available evidence and patient’s and patient’s integrated with the in the face of uncertain apply evidence for
how to incorporate the family’s preferences and patient’s and patient’s and/or conflicting patients and patients’
patient’s and patient’s values to guide evidence- family’s preferences, to evidence, to guide care, families; and/or
family’s preferences and based care the care of patients tailored to the individual participates in the
values into the care of patient and the patient’s development of guidelines
patients family
Comments:

18
Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Growth

Accepts responsibility for Demonstrates openness Seeks performance data Consistently seeks Role models consistently
personal and to performance data episodically with performance data with seeking performance data
professional (feedback and other adaptability and humility adaptability and humility with adaptability and
development by input) to inform goals humility
establishing goals
Identifies the factors that Analyzes and reflects on Analyzes, reflects on, and Challenges Coaches others on
contribute to gap(s) the factors that contribute institutes behavioral assumptions and reflective practice
between expectations to gap(s) between change(s) to narrow the considers alternatives in
and actual performance expectations and actual gap(s) between narrowing the gap(s)
performance expectations and actual between expectations
performance and actual performance
Comments:

19
Professionalism 1: Professional Behavior and Ethical Principles

Identifies and describes Demonstrates Demonstrates Recognizes situations Coaches others when
potential triggers for professional behavior in professional behavior in that may trigger their behavior fails to
professionalism lapses routine situations and complex or stressful professionalism lapses meet professional
and how to report them takes responsibility for situations and intervenes to expectations
own professionalism prevent lapses in
lapses oneself and others
Demonstrates Analyzes straightforward Analyzes complex Recognizes and uses Identifies and seeks to
knowledge of the ethical situations using ethical situations using ethical appropriate resources address system-level
principles underlying the principles principles and recognizes for managing and factors that induce or
care of cancer patients need to seek help in resolving ethical exacerbate ethical
managing and resolving dilemmas as needed problems or impede their
complex ethical situations resolution
Comments:

20
Professionalism 2: Accountability/Conscientiousness

Takes responsibility for Performs tasks and Performs tasks and
failure to complete tasks responsibilities in a timely responsibilities in a timely
and responsibilities, manner with appropriate manner with appropriate
identifies potential attention to detail in attention to detail in
contributing factors, and routine situations complex or stressful Recognizes situations
describes strategies for situations that may impact others’ Takes ownership of
ensuring timely task ability to complete tasks system outcomes
completion in the future and responsibilities in a
timely manner
Responds promptly to Recognizes situations Proactively implements
requests or reminders to that may impact one’s strategies to ensure that
complete tasks and own ability to complete the needs of patients,
responsibilities tasks and responsibilities teams, and systems are
in a timely manner met
Comments:

21
Professionalism 3: Well-Being

Recognizes status of Independently recognizes With assistance, Independently develops Coaches others when
personal and status of personal and proposes a plan to a plan to optimize emotional responses or
professional well-being, professional well-being optimize personal and personal and limitations in knowledge/
with assistance professional well-being professional well-being skills do not meet
professional expectations
Recognizes limits of the Independently recognizes With assistance, Independently develops

team, with assistance status of personal and proposes a plan to a plan to optimize
professional well-being of optimize personal and personal and
the team professional well-being of professional well-being
the team of the team
Comments:
This subcompetency is not intended to evaluate a fellow’s well-being. Rather, the intent is to ensure that each fellow has the fundamental
knowledge of factors that affect well-being, the mechanisms by which those factors affect well-being, and available resources and tools to
improve well-being.

22
Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication

Establishes a Establishes a therapeutic Establishes a therapeutic Uses shared decision Mentors others in
professional rapport with relationship in relationship in challenging making to align situational awareness and
patients and patients’ straightforward patient patient and patient family patients’/patients’ critical self-reflection to
families and and patient family encounters and families’ values, goals, consistently develop
communicates in a clear encounters and acknowledges uncertainty and preferences with positive therapeutic
and understandable compassionately delivers in alignment of goals treatment options to relationships
manner medical information make a personalized
care plan
Identifies common Identifies complex When prompted, reflects Independently Role models self-
barriers to effective barriers to effective on personal biases while recognizes personal awareness while
communication (e.g., communication (e.g., attempting to minimize biases while attempting identifying a contextual
language, disability) health literacy, cultural communication barriers to proactively minimize approach to minimize
differences) communication barriers communication barriers
Comments:

24
Interpersonal and Communication Skills 2: Interprofessional and Team Communication

Uses language that Communicates Uses active listening to Coordinates Role models flexible
values all members of information clearly with all adapt communication recommendations from communication strategies
the health care team health care team style to fit team needs different members of that value input from all
members the health care team to health care team
optimize patient care members, resolving
and maintains effective conflict when needed
communication in crisis
situations
Respectfully receives Solicits feedback on Communicates concerns Communicates Facilitates regular health
feedback on performance as a and provides feedback to feedback and care team-based
performance as a member of the health peers and learners constructive criticism to feedback in complex
member of the health care team superiors situations
care team
Comments:

25
Interpersonal and Communication Skills 3: Communication within Health Care Systems

Accurately records Demonstrates organized Concisely integrates all Communicates clearly, Coaches others to
information in the patient diagnostic and relevant data from outside concisely, timely, and in improve written
record therapeutic reasoning systems and prior an organized written communication
through notes in the encounters and reports form, including
patient record diagnostic and anticipatory guidance
therapeutic reasoning in
the patient record
Communicates through Demonstrates efficient Maintains effective and Role model for Guides departmental or
appropriate channels as use of appropriate respectful communication individual institutional
required by institutional channels to communicate during emergent and communication across communication around
policy (e.g., patient with the health care team stressful situations the system policies and procedures
safety reports, cell
phone/pager usage)
Comments:

26

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Pediatric Surgery Milestones

The Accreditation Council for Graduate Medical Education

Implementation: July 2022

©2021 Accreditation Council for Graduate Medical Education (ACGME)

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Samuel Alaish, MD Barbara Gaines, MD

Pediatric Surgery Board, American Board of Surgery

Review Committee for Surgery

©2021 Accreditation Council for Graduate Medical Education (ACGME)

©2021 Accreditation Council for Graduate Medical Education (ACGME)

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Selecting a response box on the line in

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Patient Care 1: Patient Evaluation and Clinical Decision Making

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Patient Care 2: Intra-Operative Patient Care – Endoscopy Procedural Skills

Level 1 Level 2 Level 3 Level 4 Level 5

Recognizes intra- With active assistance, Independently Independently Anticipates and

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Level 1 Level 2 Level 3 Level 4 Level 5

Recognizes intra- With assistance, Independently Independently Anticipates and prevents

Not Yet Completed Level 1

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Level 1 Level 2 Level 3 Level 4 Level 5

Recognizes intra- With assistance, Independently manages, Independently Independently

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Level 1 Level 2 Level 3 Level 4 Level 5

Recognizes intra- With assistance, Independently manages, Independently Independently

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Level 1 Level 2 Level 3 Level 4 Level 5

Recognizes intra- With assistance, Independently manages, Independently Independently

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Level 1 Level 2 Level 3 Level 4 Level 5

Recognizes intra- With assistance, Independently manages, Independently Independently

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Patient Care 9: Post-Operative Care (Short- and Long-Term)

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Patient Care 10: Critical Care

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Patient Care 11: Trauma Management

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Medical Knowledge 1: Anatomy

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Medical Knowledge 2: Developmental Biology and Neonatal Physiology

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Medical Knowledge 3: Pediatrics and Pediatrics Surgery

Level 1 Level 2 Level 3 Level 4 Level 5

Demonstrates knowledge Demonstrates basic Demonstrates Contributes to peer-

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Systems-Based Practice 1: Patient Safety and Quality Improvement

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)

Systems-Based Practice 2: System Navigation for Patient-Centered Care

Level 1 Level 2 Level 3 Level 4 Level 5

©2021 Accreditation Council for Graduate Medical Education (ACGME)