Milestones: a rapid assessment method for the Clinical Competency Committee

Area of Science:

• Medical Education
• Graduate Medical Training
• Competency Assessment

Background:

• U.S. graduate medical residency programs utilize educational milestones for developmental progress assessment.
• Clinical Competency Committees (CCCs) annually report milestone determinations to the Accreditation Council for Graduate Medical Education (ACGME).
• Traditional CCC deliberations using milestones were found to be time-intensive.

Purpose of the Study:

• To test a modified CCC approach for rapid and accurate resident milestone assessments.
• To evaluate the impact of pre-meeting ratings and in-meeting reconciliation on CCC efficiency and reliability.

Main Methods:

• Modified the CCC process to include pre-meeting faculty ratings of resident milestones.
• Implemented in-meeting reconciliation of faculty ratings.
• Assessed reliability by comparing individual assessments with collective CCC assessments.

Main Results:

• Reduced committee deliberation time per resident from 25 to 9 minutes (p < 0.001).
• Faculty reported improved ability to identify and assess competency development using milestones (p = 0.026).
• Individual assessments showed good agreement with collective CCC assessments.

Conclusions:

• The modified CCC process, with pre-meeting ratings and in-meeting reconciliation, shortened deliberation times.
• This approach enhanced evaluator satisfaction and yielded reliable milestone assessments.
• Optimized Clinical Competency Committee processes improve graduate medical education evaluation.