Evaluating Neurosurgery Resident Competency: A Comparative Study of Milestones 1.0 and 2.0 Across 10 Years

Area of Science:

• Medical Education
• Neurosurgery Training
• Competency-Based Assessment

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) implemented Neurosurgery Milestones to advance competency-based training.
• Limited research exists on neurosurgery milestones, and no comprehensive study has compared Milestones 1.0 and 2.0.
• This study examines milestone ratings and trends over a decade of implementation.

Purpose of the Study:

• To describe competency rating levels and trends for neurosurgical residents in the US.
• To analyze data across Milestones 1.0 and 2.0 over a ten-year period.
• To assess both nontechnical competencies and critical technical skills.

Main Methods:

• Retrospective analysis of milestone assessments from 124 US neurosurgery residency programs (2013-2023).
• Included both Milestones 1.0 (2013-2018) and Milestones 2.0 (2018-2023).
• Descriptive statistics used to examine rating distributions and performance trends by postgraduate year (PGY).

Main Results:

• In Milestones 1.0, Professionalism had the highest average rating (3.17), while Patient Care was lowest (2.89).
• Milestones 2.0 showed a shift: Interpersonal and Communication Skills were highest for early PGY levels, Medical Knowledge for senior residents.
• Patient Care remained the lowest-scoring competency; Critical Care and Brain Tumor management scored high, while Epilepsy, Pain/Nerve, and Pediatric Neurosurgery showed lower scores.

Conclusions:

• A balance between nontechnical and technical skills is crucial for comprehensive neurosurgical training.
• Established benchmarks can improve milestone data utility.
• This supports the development of well-rounded, competent neurosurgeons.