The Milestones provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. The Milestones are designed only for use in evaluation of resident physicians in the context of their participation in Accreditation Council for Graduate Medical Education (ACGME)–accredited residency or fellowship programs. They neither represent the entirety of the dimensions of the 6 domains of physician competency, nor are they designed to be relevant in any other context.
Milestone Reporting
This document presents Milestones designed for programs to use in semiannual review of resident performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for resident performance as a resident moves from entry into residency through graduation. In the initial years of implementation, the Review Committee will examine Milestone performance data for each program's residents as 1 element in the Next Accreditation System (NAS) to determine whether residents overall are progressing.
For each reporting period, review and reporting will involve selecting the level of Milestones that best describes each resident's current performance level in relation to the Milestones. Milestones are arranged into numbered levels. Selection of a level implies that the resident substantially demonstrates the Milestones in that level, as well as those in lower levels (see figure). A general interpretation of levels for the Ophthalmology Milestones is below:
Level 1: The resident demonstrates Milestones expected of a resident who has had some education in ophthalmology.
Level 2: The resident is advancing and demonstrating additional Milestones.
Level 3: The resident continues to advance and is demonstrating additional Milestones; the resident consistently demonstrates the majority of Milestones targeted for residency.
Level 4: The resident has advanced so that he or she now substantially demonstrates the Milestones targeted for residency. This level is designed as the graduation target.
Level 5: The resident has advanced beyond performance targets set for residency, and is demonstrating aspirational goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this level.
Additional Notes
Level 4 is designed as the graduation target but does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the residency program director (see the NAS Frequently Asked Questions for educational Milestones on the ACGME's website for further discussion of this issue: “Can a resident graduate if he or she does not reach every Milestone?”). Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether Level 4 Milestones and Milestones in lower levels are in the appropriate level within the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions.
Some Milestone descriptions include statements about performing independently. These activities must follow the ACGME supervision guidelines. For example, a resident who performs a procedure or takes independent call must, at a minimum, be supervised through oversight.
An Appendix that describes Milestones for specific patient examination skills and office diagnostic, nonoperating room, and operating room procedures related to PC-2, PC-3, PC-6, and PC-7 is also available, and can be found on the ACGME's Milestone webpage, as well as on the Review Committee webpage. Evidence that a resident demonstrates Milestones for these skills and procedures should be used by the program's Clinical Competency Committee as the basis for reporting semiannually on a resident's performance level on PC-2, PC-3, PC-6, and PC-7. Special Note for PC-2, PC-3, PC-6, PC-7: When selecting a level of performance for a resident on these sets of Milestones, which require synthesizing performance across a number of specific skills or procedures, and the resident is at different levels for different skills or procedures, the level selected should reflect the level where the majority of skills or procedures were rated. The level selected could be between Milestone levels, as allowed by the Milestone report.
ACGME Milestone Report Form
The Figure presents an example set of Milestones for 1 subcompetency in the same format as the Milestone Report Form. For each reporting period, a resident's performance on the Milestones for each subcompetency will be indicated by:
selecting the level of Milestones that best describes the resident's performance in relation to those Milestones, or
selecting the “Has Not Achieved Level 1” option.
