Examining the Functioning and Reliability of the Family Medicine Milestones

The Family Medicine (FM) Milestones are a framework designed to assess development of residents in key dimensions of physician competency. Residency programs use the milestones in semiannual reviews of resident performance from entry toward graduation.

To examine the functioning and reliability of the FM Milestones and to determine whether they measure the amount of a latent trait (eg, knowledge or ability) possessed by a resident or simply indicate where a resident falls along the training sequence.

This study utilized the Rasch Partial Credit model to examine academic year 2014-2015 ratings for 10 563 residents from 476 residency programs (postgraduate year [PGY] 1 = 3639; PGY-2 = 3562; PGY-3 = 3351; PGY-4 = 11).

Reliability was exceptionally high at 0.99. Mean scores were 3.2 (SD = 1.3) for PGY-1; 5.0 (SD = 1.3) for PGY-2; 6.7 (SD = 1.2) for PGY-3; and 7.4 (SD = 1.0) for PGY-4. Keyform analysis showed a rating on 1 item was likely to be similar for all other items.

Our findings suggest that FM Milestones seem to largely function as intended. Lack of spread in item difficulty and lack of variation in category probabilities show that FM Milestones do not measure the amount of a latent trait possessed by a resident, but rather describe where a resident falls along the training sequence. High reliability indicates residents are being rated in a stable manner as they progress through residency, and individual residents deviating from this rating structure warrant consideration by program leaders.