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 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 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 general surgery is below:
Critical Deficiencies: These learner behaviors are not within the spectrum of developing competence. Instead they indicate significant deficiencies in a resident's performance.
Level 1: The resident is demonstrating 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: 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.
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.
Milestones in the medical knowledge (MK) and patient care (PC) competencies reference the Surgical Council on Resident Education's (SCORE) curriculum. Familiarity with the SCORE categories of “broad” and “focused” diseases/conditions and “essential-common,” “essential-uncommon,” and “complex” operations/procedures will be particularly helpful. Program faculty members will need to develop a shared understanding of what the common (ie, commonly seen) SCORE broad conditions are in their hospitals and clinics for MK1 and PC1. An overview of the SCORE curriculum is available at http://www.surgicalcore.org/media/curriculumoutline2012-13.pdf. Links to the curriculum outline are also embedded in selected Milestones.
Some Milestones extend current expectations. One example of this is PBLI3, levels 3 and 4, which include expectations for the resident to review his or her own surgical results and medical care outcomes and to identify opportunities for improvement. These specific Milestones were included to prepare senior and graduating residents for becoming diplomates of the American Board of Surgery and for Maintenance of Certification Part 4, which requires outcomes review and practice improvement.
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 the Milestones, or
selecting the “Critical Deficiencies” response option.
