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Milestones and You
Laura Edgar, EdD, CAEVice President, Milestone Development
©2019 ACGME
• Full-time employee of ACGME
Disclosures
©2019 ACGME
• Milestones Background
• Milestones Structure
• Considerations for the Milestones in your program
• Milestones 2.0
Presentation Outline
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Milestones Background4
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• Describe performance levels for skills, knowledge, and behaviors in the six competency domains.
• Provide a framework of observable behaviors and attributes associated with residents’ development as physicians.
• Used as one indicator of a program’s educational progress
Milestones: What?
Nasca, TJ et. Al. The Next Accreditation System. 2012.366:1051-1056
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• What do they know?
• What can they do?
• How do they conduct themselves?
• Competencies must be in concert to demonstrate the competent graduate
Milestones – What?
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Purposes and Implications
ACGME
• Accreditation – continuous quality improvement (CQI)
• Public Accountability – focus nationally on important competency outcomes
• Community of practice for evaluation and research, with focus on continuous improvement
Training Programs
• Framework for CCC• Guide curriculum development• More explicit expectations of trainees• Support better assessment• Enhanced opportunities for early
identification of under-performers
High Stakes
• Research ONLY
• Not intended for SMB use
Residents and Fellows
• Increased transparency of performance requirements
• Encourage informed self-assessment and self-directed learning
• Better feedback• Facilitate individualized learning plans
Milestones
Milestones are a Formative Assessment Framework
©2019 ACGME
• Articulate shared understanding of expectations
• Describe trajectory from a beginner in the specialty to
an exceptional resident or practitioner
• Organized under six domains of clinical competency
• Represent a subset of all sub-competencies
• Set aspirational goals of excellence
Key Points: Milestones
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Milestones Structure9
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Milestone Template
10
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11
Milestone Template –
Osteopathic Recognition
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• 7 additional subcompetencies
• Evaluated in conjunction with the specialty specific milestones
• Only evaluated for Residents/Fellows in the Osteopathic Recognition Track
Osteopathic Recognition
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• Family Medicine (FM) Resident in the Osteopathic Recognition (OR) Track
• FM Patient Care 2: Cares for Patients with Chronic Conditions
• OR Patient Care 2: Examination, Diagnosis, and Treatment
• These can be evaluated simultaneously
• You may need to re-evaluate your assessment tools to ensure you are capturing appropriate Osteopathic principles
Osteopathic Recognition -
Example
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Option to select “Not Yet Completed Level 1” or “Not
Yet Assessable”
Milestones are progressive over time. There is no prescribed speed at which
residents must complete a milestone set.
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• An attempt to define an explicit, practical, relevant, and
manageable set of domains of clinical competence
• An attempt to describe levels of competency development
during training, leading to unsupervised practice of medicine
• A way to better inform trainees of the expectations of training
What the Milestones Are
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• Not everything a graduating resident needs to know
or be able to do
• Not a mandate for specific rotations or durations of
experience
• Not a replacement for regular assessment and
evaluation
What the Milestones are Not
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• Available resources: faculty time, evaluation forms
• Variations in engagement and attitudes within programs
• Learning curve: Evaluating, aggregating, and reporting become easier as you and your program become more familiar with the process
Milestones Considerations
17
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• All programs within a specialty use the specialty’s milestones
• Programs will report semi-annually
• Milestone data will be reported to ACGME through direct entry into the Accreditation Data System (ADS)
Milestones: Reporting
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• Residents/Fellows should receive a report of their
Milestones ratings following CCC meetings
• Ideally, residents/fellows perform self-evaluations
beforehand
Feedback to Residents and
Fellows
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• Coming Soon
Milestones 2.0
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• Too much!
• Dissatisfaction with non-PC/MK
• More people want to participate
What have we learned?
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What changed?
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What changed?
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Differences
Patient Care and Medical Knowledge have two options
outside of the levels:
• Not yet completed Level 1/Critical Deficiencies
• Not yet rotated/ Not yet assessable
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Supplemental Guide
Examples for Levels 1-5
Assessment methods
Resources
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Supplemental
Guide
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Supplemental Guide
Review the Milestones and Supplemental guide with
your CCC
Your CCC should do a shared mental model exercise
Program’s expectations at each level
Assessment tool(s) you will use
Rotations each will be assessed
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Where do I find...?
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Assessment 101
Introduction to Milestones
Coming soon:
Milestones 2.0 webcasts
<10 minute webcast to explain 2.0 to faculty
Courses Available On Demand
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Other Resources
©2019 ACGME
Other Resources
©2019 ACGME
Milestones:
Laura Edgar
Here to help