Associations Between Medical School Metrics and Early Pediatric Resident Milestones.

Background: Residency programs utilize holistic review processes to identify applicants prepared for early clinical responsibility, yet limited evidence links undergraduate medical education (UME) metrics with Accreditation Council for Graduate Medical Education (ACGME) Milestone-based performance. Objective: To determine which UME factors are associated with early pediatric residency performance as measured by the ACGME Milestones. Methods: This multi-institutional, retrospective cohort study included medical students who graduated and completed at least one year of residency in categorical pediatrics between 2014 and 2018. We collected United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge scores, overall pediatric clinical performance assessment scores, other required clerkship grades, National Board of Medical Examiners (NBME) Pediatrics Subject Examination scores, leadership roles, research/scholarly activity, and honorary society membership. The primary outcomes were ACGME midyear Milestone data for postgraduate year 1 residents. Linear mixed models with random and fixed effects were used for data analysis. Results: Of 451 eligible graduates from 5 participating sites, 414 (91.8%) were included in the analysis, with Milestone data available for 228 (55.1%). The NBME Examination score was the only covariate associated with all 6 Core Competency Milestones ( Conclusions: Pediatric NBME scores and clinical performance grades were associated with either all or select midyear Milestone competencies in the first year of pediatrics residency.