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. 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 a resident's current performance level in relation to Milestones, using evidence from multiple methods, such as direct observation, multisource feedback, tests, and record reviews, etc. Milestones are arranged into numbered levels. These levels do not correspond with postgraduate year (PGY) of education.
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 physical medicine and rehabilitation is below:
Level 1: The resident demonstrates Milestones expected of an incoming resident.
Level 2: The resident is advancing and demonstrates additional Milestones, but is not yet performing at a midresidency level.
Level 3: The resident continues to advance and demonstrate additional Milestones; the resident demonstrates the majority of Milestones targeted for residency in this subcompetency.
Level 4 (Graduation Target): 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 (Aspirational): 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 and 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.
The “Has Not Achieved Level 1”option indicates that the resident has not substantially demonstrated Level 1 Milestones. This option is appropriate for when the resident has not had an opportunity to learn and demonstrate the Milestones (eg, for PGY-1 residents who are learning basic clinical skills and have not yet had the relevant physical medicine and rehabilitation rotation/learning experience) or when the resident is performing suboptimally. Regardless of the cause, the implication is that the resident needs future learning opportunities related to this Milestone.
The Review Committee requires reporting on only the single Medical Knowledge Milestone that reflects progress to date on acquiring and applying a broad base of physiatric knowledge. The appendix contains Milestones in 9 specific Medical Knowledge areas that programs may use in developing curriculum, clinical rotations, and evaluation of residents. When assigning a rating on the single Medical Knowledge Milestone, the Clinical Competency Committee should take into consideration such items as the breadth of the resident's experience to date, the resident's performance in the 9 specific areas of Medical Knowledge, other aspects of Medical Knowledge the program deems important, and performance on the Patient Care 4, Practice-Based Learning and Improvement 1, and Practice-Based Learning and Improvement 2 Milestones.
There are references to “across a spectrum of ages” in several Milestone sets. “Across a spectrum of ages” includes pediatric to geriatric rehabilitation populations. Competency at the level of a physical medicine and rehabilitation generalist (as opposed to physical medicine and rehabilitation subspecialist) is expected.
ACGME Milestone Report Form
The figure presents an example set of Milestones for 1 subcompetency in the same format as the ACGME 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 the Milestones, or
selecting the “Has Not Achieved Level 1” response option.
For each general competency domain, the ACGME Report Form asks for an overall assessment of each resident's learning trajectory. An example overall assessment statement is presented below.
Patient Care. The resident is demonstrating satisfactory development of the knowledge, skills, and attitudes/behaviors needed to advance in residency. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that includes the delivery of safe, timely, equitable, effective, and patient-centered care.
_____Yes _______No
