The American Board of Pediatrics (ABP) regards the evaluation of trainee competency as a continuum that begins during training and concludes with the certifying examination following formal training. The ABP believes that the program director (s) and faculty play significant roles in the certification process and are the keys to a responsible system of determining which applicants should be admitted to the certifying exam. The program director is able to provide a meaningful overview of the resident's or fellow's professional competence, especially in skills such as patient care and procedural skills, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement and systems-based practice.

The ABP tracking and evaluation program is part of the certifying process of the ABP. The program director is required to indicate annually whether each resident's or fellow's performance is satisfactory, marginal or unsatisfactory in overall clinical competence and whether the evaluation in professionalism is satisfactory or unsatisfactory. A marginal rating implies that more time and information are needed to determine whether the performance is satisfactory or unsatisfactory.

Learn more about Physician Competencies, as defined by the ABP and Accreditation Council for Graduate Medical Education (ACGME).

Unsatisfactory Clinical Competence

An unsatisfactory evaluation in clinical competence for a year of training results in no credit for that training year. The resident or fellow must repeat the year in the same program or another program.

Marginal Clinical Competence

The program director has two options from which to choose:

1. Marginal with Advancement to Next Level: Marginal evaluation at the end of the academic year with advancement to the next level means the resident has earned 12 months of training credit and moves to the next level. Remediation may occur while the resident is training at the next training level.
2. Marginal with Extension at Same Level: This evaluation means more time is needed to make a valid assessment while the trainee continues to train at the same level. The program director will be asked to provide the anticipated completion date of the extended level of training. In many cases, an extension is necessary because the resident must repeat failed rotations. In those cases, even if the resident is successful on the completed rotation, there must be an extension of training beyond the usual 3 years. No partial credit for the level is recorded, as this is an interim evaluation. At the end of the extended period of training, the ABP requests an evaluation of the full year of training. If the evaluation is satisfactory, the resident will receive full credit (12 months). It is also possible that the evaluation at the end of the extension will remain marginal with advancement to the next level or become unsatisfactory with no credit.

A resident or fellow may receive credit for the training year if he or she receives a marginal rating in clinical competence; however, if the following year of training is also marginal, no credit is allowed for the latter year.

If a resident or fellow transfers after receiving a marginal evaluation with partial credit and then receives an unsatisfactory evaluation at the same training level, no credit for the year of training will be granted.

Residents in combined medicine-pediatrics training will receive a separate evaluation in each specialty and the number of months of credit in each specialty is collected. If either clinical evaluation is marginal or unsatisfactory, the yearly evaluation will be recorded as marginal or unsatisfactory. In addition to the evaluation, the program directors are asked to provide the number of months of credit the resident received in each specialty.

The following table illustrates the consequences of receiving an unsatisfactory or marginal evaluation in clinical competence at the end of each level of training. Residents and fellows must receive a satisfactory rating in each of the components of clinical competence during the final year of required training. It is the resident's or fellow's responsibility to arrange for any additional training required.

Ratings for professionalism (which includes moral/ethical behavior) must be either satisfactory or unsatisfactory. If an unsatisfactory evaluation is given for professionalism, the resident or fellow must repeat the year of training or, at the discretion of the ABP and recommendation by the program director, complete a period of observation. A resident or fellow who receives an unsatisfactory evaluation for professionalism receives no credit for that year of training unless the program director provides evidence as to why a period of observation rather than a repeat year of training should be completed.

The tracking system also identifies residents and fellows who transfer from one program to another or to a new specialty and assures that the new program director recognizes those residents and fellows who need remediation. A transfer form must be completed by the program director and submitted to the ABP. Summary evaluations will be sent to the new training program if a resident or fellow transfers.

Program directors are encouraged to have all residents take the General Pediatrics In-Training Exam and fellows to take the Subspecialty In-Training Exam. The results from these exams provide valuable information for residents, fellows, and program directors.