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Many medical specialties lack critical deficiency (CD) ratings in their Accreditation Council for Graduate Medical Education (ACGME) milestones. However, one program found CDs in over a third of residents, highlighting the need for standardized CD assessment in graduate medical education.

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Area of Science:

  • Medical Education
  • Graduate Medical Training Assessment

Background:

  • The Accreditation Council for Graduate Medical Education (ACGME) mandates specialty-specific milestones for reporting learner progress.
  • The optimal method for utilizing milestones to identify critical deficiencies (CDs) in trainee performance remains unclear.
  • Milestones were developed independently across specialties, leading to variability in the inclusion of CD ratings.

Purpose of the Study:

  • To determine the proportion of ACGME milestone sets that incorporate CD ratings.
  • To describe the experience of a single residency program in using CD ratings for trainee assessment.

Main Methods:

  • A review of ACGME milestones for all 99 specialties was conducted in November 2015 to identify the presence of CD rating scales.
  • Three years of assessment data (July 2012-June 2015) from the University of Cincinnati Medical Center (UCMC) internal medicine residency program were analyzed.
  • Data were stratified by postgraduate year, assessor type, rotation, academic year, and core competency, with statistical analysis including the Mantel-Haenszel chi-square test.

Main Results:

  • A significant heterogeneity was observed, with 22% of specialties lacking explicit language for CDs in their milestone assessments.
  • At the UCMC internal medicine residency, 33% of residents received at least one CD rating.
  • CDs constituted a small fraction (0.18%) of all assessment ratings but were identified across various core competencies and rotations.

Conclusions:

  • Despite variability in milestone development, a substantial number of residents can be identified with CDs during training, as demonstrated by the UCMC experience.
  • The identification of CDs is crucial for developing targeted remediation and improvement plans for trainees.
  • Standardizing the inclusion and utilization of CD ratings within ACGME milestones could enhance the consistency and effectiveness of performance assessment in graduate medical education.