Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?

Area of Science:

• Medical Education
• Emergency Medicine Training
• Graduate Medical Education

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) established 23 educational milestones for emergency medicine (EM) residencies.
• Level 1 was conceptualized as the expected proficiency for an incoming postgraduate year-1 (PGY-1) resident, but this benchmark has not been empirically validated.
• Assessing initial resident competency is crucial for tailoring educational interventions.

Purpose of the Study:

• To determine the percentage of incoming PGY-1 residents who achieved Level 1 proficiency in 8 emergency department (ED) patient care milestones, as evaluated by faculty.
• To compare faculty assessments with resident self-assessments for these milestones.
• To quantify the discrepancies between self- and faculty-based performance evaluations.

Main Methods:

• Incoming PGY-1 residents from 4 EM programs were assessed by faculty and themselves within their first month of residency.
• Performance anchors for the assessments were adapted from established ACGME milestones.
• Data were collected on resident achievement of Level 1 for 8 specific patient care milestones (PC 1-8).

Main Results:

• Faculty assessments indicated that the percentage of residents achieving Level 1 ranged from 20% to 73% across the 8 milestones.
• Self-assessments showed a higher range of achievement, from 34% to 92%.
• A majority of residents failed to achieve Level 1 on faculty assessment for milestones PC-2, PC-3, PC-5a, and PC-6, and on self-assessment for PC-3 and PC-5a. Self-assessments were consistently higher for PC-2, PC-5b, and PC-6.

Conclusions:

• Less than 75% of incoming PGY-1 residents met the Level 1 benchmark for essential ED patient care milestones.
• Significant proportions of residents did not achieve Level 1 in 4 key milestones, indicating a need for targeted early training.
• Discrepancies between self- and faculty assessments suggest potential overconfidence among residents or differing evaluation standards.