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Investigating Program Differences in ACGME General Surgery Milestone 2.0 Ratings: Medical Knowledge and
Claire Ferguson1, Natasha Becker2, Jonathan Greer3
1Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, State University of New York Downstate Health Sciences University, Brooklyn, New York.
Journal of Surgical Education
|October 16, 2025
Summary
Program variations significantly impact general surgery resident milestone ratings for medical knowledge and practice-based learning. These variations, potentially due to rating practices, highlight the need for consistent evaluation to reflect individual competency.
Area of Science:
- Medical Education
- Surgical Residency Training
- Competency-Based Assessment
Background:
- Accreditation Council for Graduate Medical Education (ACGME) milestone ratings may show significant program-level variation.
- Understanding this variation is crucial for accurate resident assessment.
Purpose of the Study:
- To investigate program-level variation in general surgery milestone ratings for medical knowledge (MK) and practice-based learning and improvement (PBLI).
Main Methods:
- Retrospective observational study of 2020-2021 milestone data from 7,581 residents across 328 general surgery programs.
- Analysis included descriptive statistics and intraclass correlation coefficients (ICCs) to quantify program-level variance.
- Uniform rating practices and program size comparisons were also conducted.
Main Results:
- Program-level differences accounted for a substantial portion of the variance in MK and PBLI milestone ratings (32.3%–64.8%).
- Variations most significantly impacted ratings for first-year (PGY1) and final-year (PGY5) residents.
- Up to 36% of programs used uniform rating practices, with smaller programs more likely to do so.
Conclusions:
- A significant portion of milestone rating variance is attributable to the residency program, not solely individual resident performance.
- Inconsistent clinical competency committee (CCC) rating practices may drive these variations.
- Further research is needed to ensure fair and consistent milestone evaluations that accurately reflect individual resident competency.
