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The Initiative on Subspecialty Clinical Training and Certification (SCTC): Background and Recommendations

Stevenson DK, McGuinness GA, Members of Task Force on SCTC

Role of the American Board of Pediatrics
The American Board of Pediatrics (ABP) certifies general pediatricians and pediatric subspecialists based on standards of excellence that lead to high-quality health care during infancy, childhood, adolescence, and the transition into adulthood. Thus, central to the ABP’s mission is assurance to the public that a general pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills the continuous evaluation requirements that encompass the 6 core competencies of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). The ABP’s quest for excellence is evident in its rigorous evaluation process and in new initiatives undertaken that not only continually improve the standards of its certification but also advance the science, education, study, and practice of pediatrics.

The ABP’s responsibilities and authorities in standard setting and evaluation overlap through interest and influence the responsibilities and authorities assumed by the ACGME through its Pediatric Review Committee in the area of training, as well as those of the American Academy of Pediatrics and the subspecialty societies with respect to advocacy and education. Although the respective organizations have distinct missions and roles, they often work in collaboration and synergy regarding training and advocacy. Nonetheless, standard setting, evaluation, and certification remain the sole purview of the ABP. Because of the centrality of accredited training to certification, a decision by the ABP to offer a subspecialty certificate leads to a petition to the ACGME to accredit training programs. The ABP provides substantial input to the development of initial subspecialty program requirements and periodic revisions through its respective subboards, and the ABP standards for certification heavily influence the content of program requirements.

Competency-Based Medical Education
In the late 1990s, the ACGME and ABMS introduced the concept of competency-based medical education (CBME) with the establishment of 6 domains of competence: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.1 Although the domains of competence have been widely adopted across medical education, the ability to measure a learner’s performance of the skills related to the competencies has emerged as a major limiting factor to realizing the full potential of CBME. To address this issue, the ACGME partnered with the member boards of ABMS in the Milestones Project. In Pediatrics, this effort refined the ACGME competencies in the context of the specialty, creating milestones that describe the behaviors of learners along a developmental continuum from the novice behaviors of the early medical student to the behaviors of the expert who is years into practice.2,3 Performance level on a subset of milestones will be reported to ACGME at 6-month intervals throughout training for each individual trainee. It is within this context that the ABP called on thought-leaders within the pediatrics community to form this task force to reassess the clinical component of fellowship training.