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ACGME NEWS AND V IEWS

Organization of the Educational Ingrid Philibert, PhD, MBA


Milestones for Use in the Assessment of Timothy Brigham, MDiv, PhD
Laura Edgar, EdD, CAE
Educational Outcomes Susan Swing, PhD

Editors Note: The ACGME News and Views section of to provide a historical reference for the initial Milestones
JGME includes data reports, updates, and perspectives developed by the educational community in each specialty.
from the ACGME and its review committees. The decision
to publish the article is made by the ACGME. Number of Milestones for Patient Care and
Medical Knowledge
The Milestones in the T A B L E show a variety of approaches
to the initial Milestone sets. The number of subcompeten-

T
he Supplement to the March 2014 issue of the
Journal of Graduate Medical Education features the cies for the 6 ACGME competencies (Patient Care/
educational Milestones for 19 Accreditation Council Technical Skills, Medical Knowledge, Systems-Based Prac-
for Graduate Medical Education (ACGME)accredited tice [SBP], Practice-Based Learning and Improvement
specialties and the Transitional Year. These specialties will [PBLI], Professionalism [PROF], and Interpersonal and
enter the Next Accreditation System (NAS) on July 1, 2014. Communication Skills [ICS]) ranges from 10 for Allergy
Included with each set of Milestones is a description of and Immunology, a specialty entered after completion of a
their development, which also discusses the architecture of prior residency and 12 for Diagnostic Radiology, to 41 for
the Milestones, their envisioned use in resident evaluation Orthopaedic Surgery. The number of Milestone sets for
and program improvement, and the pilot studies to date Patient Care/Technical Skills ranges from 2 for Diagnostic
that have assessed the Milestones psychometric properties Radiology to 18 (Neurology); and the number for Medical
and feasibility of implementation and use. A supplement to
Knowledge spans 1 (Anesthesiology, Emergency Medicine,
the March 2013 issue of the Journal featured the
Pediatrics, Physical Medicine and Rehabilitation, and
Milestones for the 7 specialties that entered the NAS on
Urology) to 16 for Orthopaedic Surgery. The number of
July 1, 2013, along with an introduction to the Mile-
Milestone sets for the 4 cross-cutting competencies SBP,
stones,1 and a description of Milestone development for the
first 7 specialties that also discussed their development and PBLI, PROF, and ICS also varies considerably among
essential properties.2 specialties.
The T A B L E shows key data items for the educational
Milestone Organization
Milestones for all accredited specialties and the Transi-
tional Year. Columns in the T A B L E show the organization For many medical and hospital-based specialties the Mile-
of the Milestones, the number and type of Milestone sets stone sets are organized around Elements of Patient Care and
for each specialty, information on the origin of the the Physicians Role, while for most surgical/procedural
Milestones for the 4 cross-cutting competencies, and other specialties the Milestone sets are organized by Diagnoses,
relevant information such as whether the Milestones Disease Processes, and Technical/Procedural Skills. Seven
include suggestions for assessment. specialties (Medical Genetics, Neurology, Ophthalmology,
The T A B L E is intended as a reference for the first set of Otolaryngology, Preventive Medicine, Psychiatry, and Sur-
educational Milestones that will be reported as part of NAS gery) opted for a hybrid approach that combines both
reporting of educational outcomes. The aim is to show Elements of Patient Care and the Physicians Role and
similarities and differences among these Milestone sets, and Diagnoses, Disease Processes, and Technical/Procedural
Skills. Two specialties (Internal Medicine and Pediatrics)
organized their Milestone sets around the 6 competency
All authors are at the Accreditation Council for Graduate Medical Education. domains, and either as part of the work of the Milestone
Ingrid Philibert, PhD, MBA, is Senior Vice President, Field Activities; Timothy
Brigham, MDiv, PhD, is Senior Vice President, Education; Laura Edgar, EdD, working group or in a separate effort, mapped their specialty
CAE, is Senior Associate Director, Outcome Assessment; and Susan Swing, Milestones to Entrustable Professional Activities (EPAs).3,4
PhD, is Vice President, Outcome Assessment.
For the procedural specialties that opted for Milestone
Corresponding author: Ingrid Philibert, PhD, MBA, Senior Vice President, Field sets organized around diagnoses, disease processes, and
Activities, Accreditation Council for Graduate Medical Education, and
Executive Managing Editor, Journal of Graduate Medical Education, 515 N State technical skills, the level of detail in this approach to
Street, Suite 2000, Chicago, IL 60654, 312.755.5003, iphilibert@acgme.org Milestone organization may offer added clarity in terms of
DOI: http://dx.doi.org/10.4300/JGME-06-01-35 residents acquisition of competence to perform common

Journal of Graduate Medical Education, March 2014 177


A CG M E NE WS A N D VI E W S

TABLE Milestone Organization for All ACGME-Accredited Core Specialties and the Transitional Year

Specialty (Total Origin of Milestones for the 4


No. of Milestone Distribution Across the 6 Cross-Cutting Competencies
Milestones) Milestone Organization Competencies (PBLI, PROF, SBP, ICS)

Allergy and Elements of Patient Care and the Physicians 4 PC, 1 MK, 2 PBLI, 1 PROF, 1 SBP, and 1 ICS. Adapted from the ACGME Expert Panel
Immunology Role. Notable: The Milestone sets reflect the Set. The working group combined
The 4 PC competencies represent the phases specialized nature of A & I education, with discrete Milestone sets developed by
(10)
of PC: medical interviewing, diagnostic entrants into A & I training having the ACGME Expert Panel into a single
measures, management plans, and completed a prior residency program. Milestone set for each of the 4 cross-
coordination of care. cutting competencies.

Anesthesiology Elements of Patient Care and the Physicians 10 PC, 1 MK, 4 PBLI, 2 SBP, 5 PROF, and 3 ICS. Mixed Model. The subcompetencies
(25) Role. Notable: Professionalism for SBP, PBLI, PROF, and ICS include
Although Milestone achievement is not subcompetencies include Commitment to Milestone sets from the ACGME
strictly time based, Level 1 represents the Institution, Department, and Colleagues; Expert Panel set, and sets developed
expected performance at the end of the Giving and Receiving Feedback; and by the working group.
clinical base year. Responsibility to Maintain Personal
Emotional, Physical, and Mental Health.

Colon and Diagnoses, Disease Processes, and Technical/ 8 PC, 9 MK, 1 SBP, 1 PBLI, 1 PROF, 1 ICS. Developed by the Colon and Rectal
Rectal Surgery Procedural Skills. Notable: The Milestone sets reflect the Surgery Milestone Committee. The
The Milestone sets incorporate coordinated PC specialized nature of Colon and Rectal working group developed Milestone
(21) and MK subcompetencies for the major Surgery education, with entrants into the sets for SBP, PBLI, PROF, and ICS with
disease categories in the specialty (eg, colonic specialty having completed a residency in an emphasis on a more global
neoplasia, Crohn disease, pelvic floor disease). surgery. perspective on these competencies.

Dermatology Elements of Patient Care and the Physicians 7 PC, 5 MK, 4 SBP, 4 PBLI, 3 PROF, and 5 ICS. Mixed Model. The subcompetencies
(28) Role. for SBP, PBLI, PROF, and ICS include
The working group developed PC and MK Milestone sets from the ACGME
subcompetencies that corresponded to the Expert Panel set, sets adapted from
major subareas of dermatology as defined in the other specialties, and Milestone sets
RRCs program requirements. developed by the working group.

Emergency Diagnoses, Disease Processes, and Technical/ 14 PC, 1 MK, 3 SBP, 1 PBLI, 2 PROF, and 2 ICS. Adapted from the ACGME Expert
Medicine (23) Procedural Skills. Notable: The PC competencies include (1) Panel Set.
The Milestone sets are organized around the multitasking for emergency department
major components of emergency care. For the management and (2) patient disposition.
PC subcompetencies, Level 4 performance
expected at graduation is aligned with American
Board of Emergency Medicine certification
standards.
Milestone sets include suggestions for
assessment; use of these assessments is not
required.

Family Elements of Patient Care and the Physicians 5 PC, 2 MK, 4 SBP, 3 PBLI, 4 PROF, and 4 Adapted from the ACGME Expert
Medicine (22) Role. ICS. Panel Set.
The Milestone sets reflect the elements of Notable: The SBP subcompetencies
acute, chronic, complex, and preventive care, include Milestone sets for Advocacy for
and procedures performed by family Individual and Community Health, and
physicians. Coordination of Team-Based Care.

Internal Elements of Patient Care and the Physicians 5 PC, 2 MK, 4 SBP, 4 PBLI, 4 PROF, and 3 Developed by the Milestone Working
Medicine (22) Role, which are mapped to Entrustable ICS. Group.
Professional Activities. Notable: Internal Medicine was the first
The Milestone sets are organized as EPAs, with specialty to develop educational
Level 1 denoting the individual has critical Milestones, beginning its work in 2007,
deficiencies and is not allowed to practice the and developed an initial set of 142
EPA, and Level 4 denoting readiness for educational Milestones.
unsupervised practice.

Medical Hybrid Approach: Combining Diagnoses, 9 PC, 2 MK, 2 SBP, 2 PBLI, 3 PROF, and 2 ICS. Mixed Model. The Milestone sets for
Genetics (20) Disease Processes, and Technical/Procedural Notable: The Milestone sets reflect the fact SBP, PBLI, PROF, and ICS include some
Skills and Elements of Patient Care/ that residents enter medical genetics after Milestones from the ACGME Expert
Physicians Role. completing a minimum of 2 years of training Panel set, and Milestone sets
in an accredited residency. developed by the working group.

Neurological Diagnoses, Disease Processes, and Technical/ 8 PC, 8 MK, 2 SBP, 2 PBLI, 2 PROF, and 2 ICS. Adapted from the ACGME Expert
Surgery (24) Procedural Skills Notable: Six matched PC and MK Panel Set.
Domains in each of the 6 competencies are Milestone sets for major neurological
based on a neurosurgical matrix curriculum surgery diagnoses and patient groups (eg,
developed by the Society for Neurological Treatment of Epilepsy and Movement
Surgery, reflecting the written board Disorders, Vascular Neurosurgery).
examination topics and RRC case categories.

178 Journal of Graduate Medical Education, March 2014


ACGME NEWS AND V IEWS

TABLE Continued

Specialty (Total Origin of Milestones for the 4


No. of Milestone Distribution Across the 6 Cross-Cutting Competencies
Milestones) Milestone Organization Competencies (PBLI, PROF, SBP, ICS)

Neurology (29) Hybrid Approach: Combining Diagnoses, 18 PC, 3 MK, 2 SBP, 2 PBLI, 2 PROF, and 2 Adapted from the ACGME Expert
Disease Processes, and Technical/Procedural ICS. Panel Set.
Skills and Elements of Patient Care/
Physicians Role.
The Milestone sets include 5 global domains
(3 PC and 2 MK) that represent key
components of neurology practice, 11 PC
domains comprising major neurological
disease categories, and 4 technical/
procedural PC domains.

Nuclear Diagnoses, Disease Processes, and Technical/ 5 PC, 7 MK, 2 SBP, 2 PBLI, 1 PROF, and 2 ICS. Mixed Model. The subcompetencies
Medicine (19) Procedural Skills. Notable: The Milestone sets reflect the for SBP, PBLI, PROF, and ICS include
fact that residents enter nuclear medicine some Milestone sets from the
after prior training in an accredited ACGME Expert Panel set, and
residency, and the years of prior training Milestone sets developed by the
differ among entrants into the specialty. working group.

Obstetrics and Diagnoses, Disease Processes, and Technical/ 11 PC, 7 MK, 2 SBP, 2 PBLI, 3 PROF, and 3 ICS. Adapted from the ACGME Expert
Gynecology Procedural Skills. Notable: The Milestone sets comprise 5 Panel Set.
The PC and MK Milestone sets reflect the obstetrics subcompetencies, 9 gynecology
(28) structure of the ABOG Oral Examination, with subcompetencies, and 4 office practice
Level 4 representing the knowledge, subcompetencies.
attitudes, and skills of a graduate who is
ready to sit for the ABOG examination.

Ophthalmology Hybrid Approach: Combining Diagnoses, Disease 8 PC, 2 MK, 3 SBP, 3 PBLI, 4 PROF, and 4 Adapted from the ACGME Expert
(24) Processes, and Technical/Procedural Skills and ICS. Panel Set.
Elements of Patient Care/Physicians Role. Notable: An appendix with added PC
The PC subcompetencies are organized around subcompetencies provides sufficient
the elements of patient care and the role of the granularity for assessment of knowledge
physician. The MK subcompetencies include the and skills; programs are not required to
key ophthalmology concepts and diagnoses (eg, report data for these Milestone sets to the
Ophthalmic Pathology and Intraocular Tumors, ACGME.
Pediatric Ophthalmology and Strabismus).

Orthopaedic Diagnoses, Disease Processes, and Technical/ 16 PC, 16 MK, 3 SBP, 2 PBLI, 2 PROF, and 2 Adapted from the ACGME Expert
Surgery (41) Procedural Skills. ICS. Panel Set.
Sixteen matched PC/MK sets represent key
Orthopaedic Surgery procedures, including
anterior cruciate ligament injury, shaft fracture
of the tibia/femur, and metastatic disease.

Otolaryngology Hybrid Approach: Combining Diagnoses, 8 PC, 4 MK, 2 SBP, 1 PBLI, 1 PROF, and 1 ICS. Mixed Model. The subcompetencies
(17) Disease Processes, and Technical/Procedural Notable: In the PC and MK set for SBP, PBLI, PROF, and ICS include
Skills and Elements of Patient Care/ subcompetencies, each of the 6 some Milestone sets from the
Physicians Role. subspecialty areas of Otolaryngology has 2 ACGME Expert Panel set, and
Milestone sets. Milestone sets developed by the
working group.

Pathology Elements of Patient Care and the Physicians 7 PC, 3 MK, 7 SBP, 2 PBLI, 6 PROF, and 2 ICS. Mixed Model. For PROF, the working
Anatomic and Role. Twenty-one Milestone sets apply to group adapted the Milestone sets
anatomic and clinical pathology, 5 sets from the ACGME Expert Panel set; the
Clinical apply to anatomic pathology, and 1 applies Committee developed Milestone sets
Pathology (27), to clinical pathology. specific to Pathology for SBP, PBLI,
Anatomic and ICS.
Pathology (26),
Clinical
Pathology (22)

Pediatrics (21) Elements of Patient Care and the Physicians 5 PC, 1 MK, 3 SBP, 4 PBLI, 6 PROF, and 2 ICS. Mixed Model. The Milestone set for
Role, which are mapped to Entrustable Notable: The pediatrics community SBP, PBLI, PROF, and ICS include
Professional Activities. developed a total of 48 Milestone sets. To Milestone sets from the ACGME
The Pediatrics Milestones span the ease burden on programs, data for 21 Expert Panel set, and Milestone sets
continuum from novice performance of early Milestone sets are reported to the ACGME. developed by the working group,
medical students to the expert performance The remaining 27 sets are used in such as flexibility in adjusting to
expected of physician experts who are years curriculum formulation, resident change with capacity to alter
into practice. assessment, and program improvement. behavior, managing uncertainty, and
demonstrating trustworthiness.

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A CG M E NE WS A N D VI E W S

TABLE Continued

Specialty (Total Origin of Milestones for the 4


No. of Milestone Distribution Across the 6 Cross-Cutting Competencies
Milestones) Milestone Organization Competencies (PBLI, PROF, SBP, ICS)

Physical Elements of Patient Care and the Physicians 7 PC, 1 MK, 3 SBP, 3 PBLI, 3 PROF, and 2 ICS. Mixed Model. The subcompetencies
Medicine and Role. Notable: Nine MK subcompetencies that for SBP, PBLI, PROF, and ICS include
The PC Milestones describe important relate to common PM&R disorders are some Milestone sets from the
Rehabilitation
physiatric patient care tasks. The single MK provided as an addendum for use in ACGME Expert Panel set, and sets
(19) Milestone set encompasses the application curriculum development. Data for these developed by the working group.
and synthesis of physiatric knowledge. Milestone sets are not reported to the
ACGME.

Plastic Surgery Diagnoses, Disease Processes, and Technical/ 14 PC, 14 MK, 3 SBP, 2 PBLI, 2 PROF, and 1 Developed by the Plastic Surgery
(36) Procedural Skills. ICS. Milestone Committee. The Milestone
The PC and MK Milestone sets consist of 14 Notable: A matrix with a blend of Working Group developed Milestone
matched sets for the subcompetencies that anatomic, functional, and esthetic factors sets for SBP, PBLI, PROF, and ICS that
represent the spectrum of plastic surgery was selected to organize the MK and PC reflect specific elements in plastic
practice, and that are consistent with the Milestones. surgery practice, such as elective
training requirements outlined by the esthetic surgery, practice
American Board of Plastic Surgery and the management and marketing, and
Plastic Surgery RRC. caring for underserved populations.

Preventive Hybrid Approach: Combining Diagnoses, Shared Milestone Sets: 5 PC, 3 MK, 3 SBP, 1 Adapted from the ACGME Expert
Medicine Disease Processes, and Technical/Procedural PBLI, 2 PROF, and 2 ICS. Panel Set.
Skills and Elements of Patient Care/ Milestones sets for SBP, PBLI, PROF, and ICS
General Physicians Role. are the same for all 3 specialties. Total/
Preventive Sixteen Milestone sets are shared between unique added Milestones:
Medicine (23), General Preventive Medicine, Occupational GPM: 12/7 PC, 3/0 MK;
Occupational Medicine, and Aerospace Medicine. OM: 14/9 PC, 4/1 MK;
Medicine (26), AM: 15/10 PC, 4/1 MK.
Aerospace
Medicine (27)

Psychiatry (22) Hybrid Approach: Combining Diagnoses, 5 PC, 6 MK, 4 SBP, 3 PBLI, 2 PROF, and 2 Mixed Model. The subcompetencies
Disease Processes, and Technical/Procedural ICS. for SBP, PBLI, PROF, and ICS include
Skills and Elements of Patient Care/ Notable: Subcompetencies are Milestone sets developed by the
Physicians Role. disaggregated to emphasize specific ACGME Expert Panel and sets
behavioral components. adopted/adapted from other
Footnotes provide additional specific specialties.
information to contextualize the
Milestone sets for Psychiatry, as well as
some references to other sources and
published information.

Radiation Diagnoses, Disease Processes, and Technical/ 11 PC, 2 MK, 3 SBP, 2 PBLI, 2 PROF, and 2 Adapted from the ACGME Expert
Oncology (22) Procedural Skills. ICS. Panel Set.
Milestone sets include suggestions for Notable: Nine of 11 PC Milestone sets are
assessment; use of these assessments is not categorized according to disease type and
required. site and 2 are procedural (brachytherapy
and stereotactic radiosurgery/stereotactic
body radiotherapy).

Diagnostic Elements of Patient Care and the Physicians 2 PC, 2 MK, 2 SBP, 3 PBLI, 1 PROF, and 2 ICS. Mixed Model. The subcompetencies
Radiology (12) Role. set for SBP, PBLI, PROF, and ICS include
Milestone achievement expectations are some Milestone sets from the
linked to progression through the years of ACGME Expert Panel set and sets
Diagnostic Radiology Training. developed by the working group.

Surgery (16) Hybrid Approach: Combining Diagnoses, 3 PC, 2 MK, 2 SBP, 3 PBLI, 3 PROF, and 3 ICS. Adapted from the ACGME Expert
Disease Processes, and Technical/Procedural The Milestone sets are based on 8 distinct Panel Set.
Skills and Elements of Patient Care/ domains of surgical practice: (1) care for
Physicians Role. diseases and conditions; (2) coordination
The MK and PC Milestone sets reference the of care; (3) performance of operations and
SCORE curriculum; familiarity with the SCORE procedures; (4) self-directed learning; (5)
categories broad and focused diseases/ teaching; (6) improvement of care; (7)
conditions and essential-common, maintenance of physical and emotional
essential-uncommon, and complex is health; and (8) performance of
helpful in resident assessment. administrative tasks.

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ACGME NEWS AND V IEWS

TABLE Continued

Specialty (Total Origin of Milestones for the 4


No. of Milestone Distribution Across the 6 Cross-Cutting Competencies
Milestones) Milestone Organization Competencies (PBLI, PROF, SBP, ICS)

Thoracic Diagnoses, Disease Processes, and Technical/ 8 PC, 9 MK, 3 SBP, 2 PBLI, 2 PROF, and 1 ICS. Adapted from the ACGME Expert
Surgery (25) Procedural Skills. Panel Set.
The PC and MK Milestone sets consist of 7
matched sets for the subcompetencies that
represent the spectrum of Thoracic Surgery, as
well as 2 added subcompetencies for MK and 1
for PC. The PC and MK Milestone sets use the
curriculum developed by the American Board
of Thoracic Surgery as anchors.

Transitional For all 5-level Milestone sets, Level 3 is 7 PC, 2 MK, 3 SBP, 3 PBLI, 4 PROF, and 4 ICS. Adapted from the ACGME Expert
Year (23) designated as the target for successful Panel Set. The Expert Panels
completion of the TY year. Levels 4 and 5 Milestone sets were significantly
reflect higher performance and an revised to make them consistent with
aspirational level. the aims of a preparatory first year.
Milestone sets include suggestions for
assessment; use of these assessments is not
required.

Urology (32) Elements of Patient Care and the Physicians 9 PC, 1 MK, 4 SBP, 7 PBLI, 6 PROF, and 5 ICS. Mixed Model. The subcompetencies
Role. for SBP, PBLI, PROF, and ICS include
Performance levels for medical knowledge are some Milestone sets from the
based on the national database of performance ACGME Expert Panel set, and sets
on the Urology In-Service Examination. developed by the working group.
Milestone sets include suggestions for
assessment; use of these assessments is not
required.

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; PBLI, Practice Based-Learning and Improvement; PROF, Professionalism; SBP,
Systems-Based Practice; ICS, Interpersonal and Communication Skills; PC, Patient Care; MK, Medical Knowledge; A & I: Allergy and Immunology; RRC, Residency
Review Committee; EPA, Entrustable Professional Activity; ABOG, American Board of Obstetrics and Gynecology; PM&R, Physical Medicine and Rehabilitation;
GPM, General Preventive Medicine; OM, Occupational Medicine; AM, Aerospace Medicine; SCORE, Surgical Council on Resident Education; TY, Transitional Year.

surgical operations and tasks. At the same time, the Linkage to American Board of Medical Specialties Member
Milestone working groups using this approach acknowl- Board Examination or Specialty Curricula
edged that their approach used a sampling methodology In 8 specialties, the Medical Knowledge and Patient Care/
and does not encompass the breadth of practice in the Clinical Skills subcompetencies were explicitly linked to
specialty. In addition, the level of detail for this approach to key components of the American Board of Medical
Milestone organization may result in a greater assessment Specialties Member Board Examination (Emergency Med-
burden for programs and their Clinical Competency icine, Neurological Surgery, Obstetrics and Gynecology,
Committees (CCCs). Use of Elements of Patient Care and Plastic Surgery, and Thoracic Surgery), the In-Training
the Physicians Role and Diagnoses, Disease Processes, and Examination (Urology), or to a validated curriculum
Technical/Procedural Skills resulted in Milestone sets that developed by the specialty (Neurological Surgery, Surgery).
appear to be superior in capturing the breadth of medical
practice in the specialty, but often the individual Milestones Milestone Sets for the 4 Cross-Cutting Subcompetencies
are less likely to be around a specific set of clearly The Milestone sets for the cross-cutting Milestones for
observable characteristics, and may be more open to most specialties were adapted from a generic set of sample
interpretation about the level of performance that consti- Milestones developed by an ACGME Expert Panel. The
tutes attainment of a given Milestone. This may result in degree of adaptation varied among specialties and by the
added preparatory work for CCCs to ensure a common type of training program (true core program, educational
perspective on Milestone attainment to ensure consistent program entered after completion of a prior residency [eg,
ratings across committee members, residents, and instances Allergy and Immunology, Colon and Rectal Surgery, and
of CCC assessment. Use of EPAs in Milestone implemen- Medical Genetics]), or a preparatory program (eg, the
tation introduces a meaningful way of organizing and Transitional Year). Several specialties developed their own
integrating Milestones to correspond with higher-level Milestones for SBP, PBLI, PROF, and ICS, and a few used a
tasks performed by residents.4,5 mixed model with some Milestone sets from the Expert

Journal of Graduate Medical Education, March 2014 181


A CG M E NE WS A N D VI E W S

Panel and some developed by the Milestone Working their specialty, while for residents in training, the
Group. Milestones will enhance education and resident
assessment and will contribute to a system that assures
Added Features the safety and quality of care of patients cared for by
Seven Milestone working groups provided suggestions for residents.
tools and situations to assess the Milestones (Emergency The educational Milestones in the T A B L E should be
Medicine, Plastic Surgery, Preventive Medicine, Radiation viewed as a starting point. This information will be useful
Oncology, Thoracic Surgery, the Transitional Year, and given the envisioned evolution of the educational Mile-
Urology); these assessments are not mandated. Three Mile- stones as additional information is gleaned from pilot
stone working groups developed specific examples for use in projects, assessment studies, and the use of the Milestones
preparing CCC members for their role in Milestone scoring by programs and the ACGME.
(Colon and Rectal Surgery, Nuclear Medicine, and Otolar-
yngology). One specialty, Psychiatry, offered ample footnotes
to contextualize the specialtys educational Milestones as well References
1 Sullivan G, Simpson D, Cooney T, Beresin E. A milestone in the
as to offer references from the medical education literature.
milestones movement: the JGME milestones supplement. J Grad
Four specialties developed additional Milestones to be used Med Educ. 2013;5(1 suppl 1):14.
exclusively in resident assessment, remediation, or curriculum 2 Swing SR, Beeson MS, Carraccio C, Coburn M, Iobst W, Selden NR, et al.
Educational milestone development in the first 7 specialties to enter the
enrichment (Internal Medicine, Ophthalmology, Pediatrics, next accreditation system. J Grad Med Educ. 2013;5(1):98106.
and Physical Medicine and Rehabilitation). 3 Alliance for Academic Internal Medicine Education Redesign Committee.
Internal medicine end of training EPAs. http://www.im.org/
AcademicAffairs/milestones/Pages/EndofTrainingEPAs.aspx. Accessed
Conclusion December 12, 2013.
4 Carraccio C, Burke AE. Beyond competencies and milestones: adding
The goal of the educational Milestones is to assure that meaning through context. J Grad Med Educ. 2010;2(3):419422.
5 ten Cate O, Scheele F. Competency-based postgraduate training: can we
graduates of accredited programs have attained the bridge the gap between theory and clinical practice? Acad Med.
knowledge and skills required for unsupervised practice in 2007;82(6):542547.

182 Journal of Graduate Medical Education, March 2014

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