Developing and implementing Pediatric Nephrology Milestones 2.0 as an efficient tool for trainee evaluation and just-in-time feedback

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented Milestones 1.0 as a tool to assess trainee progress towards readiness for independent practice. Critiques of Milestones 1.0 suggested its complexity made the tool difficult to quickly understand and implement in a standardized fashion. This was particularly challenging among subspecialties due to inherent differences in clinical practice settings and make-up of procedural and patient care needs. In response, ACGME launched Milestones 2.0 in 2016 to harmonize competencies applicable to all subspecialties and develop new subspecialty specific competencies to facilitate precise feedback on subspecialty specific content domains. We describe how the Pediatric Nephrology Subspecialty Milestones were developed by a working group of pediatric nephrologists, fellows, and members of the ACGME. We highlight how this revision supports a growth-focused educational environment and equitable evaluation process. We describe how some institutions have used Milestones 2.0 to create just-in-time as well as summative feedback tools that quickly translate into individualized learning goals and guidance for programmatic improvements.