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Related Experiment Videos

ACGME Milestones Within Subspecialty Training Programs: One Institution's Experience.

Janae K Heath, C Jessica Dine

    Journal of Graduate Medical Education
    |February 27, 2019
    PubMed
    Summary

    The Accreditation Council for Graduate Medical Education Milestones show minimal rating increases and significant variability across subspecialties, suggesting potential validity issues in fellowship training. Further research is needed to refine this competency-based education framework.

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    Area of Science:

    • Medical Education
    • Graduate Medical Education
    • Competency-Based Education

    Background:

    • The Accreditation Council for Graduate Medical Education Milestones are a criterion-based framework for competency-based education in graduate medical education.
    • Evidence supporting the validity of milestones in fellowship training is limited despite widespread implementation.

    Purpose of the Study:

    • To assess the construct and response process validity of milestones in subspecialty fellowship programs.
    • To analyze milestone data for fellows in an academic medical center.

    Main Methods:

    • Retrospective cohort analysis of milestone data from 68 fellows across 5 programs (2014-2016).
    • Multivariable linear regression to evaluate changes in milestone ratings by training year and variations across subspecialties.

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  • Analysis of Professionalism and Interpersonal and Communication Skills subcompetencies for readiness for independent practice.

    • Main Results:

    • 75,933 unique subcompetency ratings were analyzed.
    • A statistically significant increase of 0.17 in ratings per postgraduate year was observed (P < .005).
    • Significant variation in milestone ratings existed across subspecialties, with mean ratings of 3.78 for Professionalism and 3.95 for Interpersonal and Communication Skills in the first six months.

    Conclusions:

    • A minimal upward trend in milestone ratings was observed in subspecialty training.
    • Significant variability in milestone implementation across subspecialties suggests potential construct validity and response process challenges.
    • The findings indicate a need to refine the milestone system for effective use in medical subspecialties.