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Exploring Program Differences in ACGME Milestone 2.0 Ratings: Interpersonal and Communication Skills and

Shaghayegh Sabbaghan Kermani¹, Claire Ferguson², Jonathan Greer¹

¹Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Journal of Surgical Education

|October 29, 2025

Summary

General surgery residency programs show significant variation in Interpersonal & Communication Skills (ICS) and Professionalism (PROF) milestone ratings. These differences may reflect institutional norms more than individual resident performance.

Keywords:

feedback and evaluation general surgery training graduate medical education milestones residency training surgical education

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Area of Science:

Medical Education
Surgical Residency Assessment
Competency-Based Education

Background:

ACGME Milestone 2.0 is crucial for evaluating resident progress.
Interpersonal & Communication Skills (ICS) and Professionalism (PROF) are key competencies.
Understanding program-level variations in these ratings is essential for fair assessment.

Purpose of the Study:

To investigate program-level variations in ACGME Milestone 2.0 ratings for ICS and PROF in general surgery residency.
To determine the extent of program influence on resident milestone assessments.

Main Methods:

Descriptive analysis of Milestone 2.0 ratings from 328 general surgery programs (2020-2021).
Intraclass correlation coefficients (ICCs) used to quantify program-level variation across PGY levels.
Wilcoxon Rank Sum tests compared program sizes for uniform vs. nonuniform rating patterns.

Main Results:

Substantial program-level variation observed in ICS and PROF ratings across all postgraduate year (PGY) levels.
Program-level differences accounted for 29.8% to 71.3% of total variance in ratings.
Uniform ratings (all residents at a PGY level receiving the same score) were common, especially in PGY1 and PGY5, and more frequent in smaller programs.

Conclusions:

Significant program-level variation exists in general surgery residency milestone ratings for ICS and PROF.
High ICCs and uniform rating patterns suggest institutional norms may influence ratings over individual performance.
Further research is needed to identify factors driving these variations and improve assessment fairness.