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 reviews 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 to determine whether residents overall are progressing.
For each period, review and reporting will involve selecting Milestone levels that best describe a resident's current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert. 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).
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, consistently including most of the 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 that 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. Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether Milestones in the first 4 levels appropriately represent the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions.
Examples are provided with some Milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element.
Some Milestone descriptions include statements about performing independently. These activities must occur in conformity with ACGME supervision guidelines, as well as institutional and program policies. For example, a resident who performs a procedure independently must, at a minimum, be supervised through oversight.
ACGME Milestone Report Form
The figure presents an example set of Milestones for 1 subcompetency in the same format as the ACGME 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 that resident's performance in relation to the Milestones, or
for Patient Care and Medical Knowledge Milestones, selecting the option that says the resident has “Not yet rotated,” or
for Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice Milestones, selecting the option that says the resident has “Not yet achieved Level 1.”
ALLERGY AND IMMUNOLOGY MILESTONES
Medical Interview and Physical Examination: Conducts Comprehensive and Detailed Medical Interviews of Children and Adults Who Present With Suspected Allergic and/or Immunologic Disorders; Performs A Physical Examination Appropriate to The Specialty—Patient Care 1
Diagnostic Tests and Procedures: Selects, Performs, and Interprets Diagnostic Tests or Procedures Appropriately—Patient Care 2
Management Plan: Designs Appropriate Management Plans for Allergic and Immunologic Disorders That Address the Indications, Risks, Benefits, and Cost of Therapy—Patient Care 3
Coordination of Care: Coordinates the Care of Allergy and Immunology Patients, Including the Use of Consultation and Effective Interactions With Faculty Members, Peers, and Support Staff; Understands the Role of Subspecialty Consultation in the Overall Care of Patients; Participates in Interdisciplinary Teams to Enhance Patient Safety—Patient Care 4
Allergy and Immunology Medical Knowledge: Understands, Applies, and Teaches Others Established and Evolving Biomedical, Clinical, and Psychosocial Sciences and Epidemiology Relevant to Patient Care; Understands Complex Disease Relationships and Mechanisms—Medical Knowledge
Uses/Accesses Outside Resources: Demonstrates Awareness of and Accommodation to Circumstances Affecting Patient Care, Including the Patient's Financial Resources and Other Factors That Can Affect Health Care Delivery and Quality; Understands the Basics of Patient Safety and Clinical Risk Management, With Emphasis on Avoidance of Medical Errors; Uses Technology and External Resources to Accomplish Safe and Effective Health Care Delivery—Systems-Based Practice
Research and Scholarly Activity: Actively Participates in Mentored Research or Scholarly Activities Such As Clinical or Laboratory-Based Investigation, Epidemiologic Study, or Continuous Quality Improvement Analysis; During Conduct of These Activities, Demonstrates the Ability to Synthesize and Apply Information From the Medical and Scientific Literature, and to Disseminate Findings—Practice-Based Learning and Improvement 1
Self-evaluates Performance: Incorporates Feedback; Identifies Strengths, Deficiencies, and Limits in Self-Knowledge and Expertise; Sets Learning and Improvement Goals in a Manner That Fosters Productive Self-Directed Learning; Actively Participates in Quality Improvement Project(S); Locates, Appraises, and Assimilates Evidence From Scientific Studies Pertinent to Patients; Uses Technology to Enhance Patient Care and Self-Improvement—Practice-Based Learning and Improvement 2
Exhibits Ethical and Responsible Behavior, Including Respect, Compassion, Honesty, and Integrity in All Aspects of Practice and Scholarly Activity: Is Accountable to Patients, Society, and the Profession and Acknowledges Errors; Maintains Responsibility for His or Her Own Emotional, Physical, and Mental Health, Including Fatigue Awareness and Avoidance, and Commitment to Lifelong Learning and Self-Assessment; Demonstrates Sensitivity to Diverse Patient, Staff, and Support Personnel Populations; Considers Needs of Patients, Families, and Colleagues—Professionalism
Provides Team-Based Care and Develops Productive Relationships With Patients, Peers, Staff Members, and Interdisciplinary Care Team Members: Ensures That Patients Understand Their Condition(s) and Treatments, Encourages Questions From Patients, and Provides Explanations Appropriate to Patient Needs; Educates and Counsels Patients, Families, and Colleagues When Appropriate; Identifies and Accommodates Special Communication Needs of Vulnerable Populations (eg, Children, Elderly, Patients With Complex Biomedical or Psychosocial Conditions, Persons With Disabilities, Immigrant and Refugee Populations, Veterans, Prisoners, LGBT [Lesbian, Gay, Bisexual, Transgender] Patients, etc); Uses Technology and Information-Sharing Modalities to Facilitate Communication—Interpersonal and Communication Skills
![Provides Team-Based Care and Develops Productive Relationships With Patients, Peers, Staff Members, and Interdisciplinary Care Team Members: Ensures That Patients Understand Their Condition(s) and Treatments, Encourages Questions From Patients, and Provides Explanations Appropriate to Patient Needs; Educates and Counsels Patients, Families, and Colleagues When Appropriate; Identifies and Accommodates Special Communication Needs of Vulnerable Populations (eg, Children, Elderly, Patients With Complex Biomedical or Psychosocial Conditions, Persons With Disabilities, Immigrant and Refugee Populations, Veterans, Prisoners, LGBT [Lesbian, Gay, Bisexual, Transgender] Patients, etc); Uses Technology and Information-Sharing Modalities to Facilitate Communication—Interpersonal and Communication Skills](https://allen.silverchair-cdn.com/allen/content_public/journal/jgme/6/1s1/10.4300_jgme-06-01s1-01/4/m_i1949-8357-6-1s1-5-t10.png?Expires=1755726194&Signature=jZ0z39zkAfsJlBqFjjKHpiMDDdRN1AKMXNCBnoRIuo04k5~0iumGsT9RUDYFVx~4KhgCUQqiH2HvYPYb82TIuN1dIS3K7KRSdDp4JRKsby7BOqNGZ3KVX4YauQ~bGycuTMxLplneBDwMGmvQSxq-Pz7YU-QCne~sVVG5nl9DErPHPvdSxU3-g3sw31RhxO3e13YL~zbFTelwhsEhnDbLnWD1Lk5XjJ06ikzLT9Kk9JtSBgnNaaCyQ-s~R17l4-WqOfIrq-C~D61uwd6Kg9RZzT3lJ0t~kSTNtzuR0JE76Z9x2zZsW6PSV3HzriTGkOY8Z~Y8kmnV47CZwrPmoQb8bg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
