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  1. Home
  3. Exploring Program Differences In Acgme Milestone 2.0 Ratings In General Surgery: Patient Care And Systems-based Practice.
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  3. Exploring Program Differences In Acgme Milestone 2.0 Ratings In General Surgery: Patient Care And Systems-based Practice.

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Exploring Program Differences in ACGME Milestone 2.0 Ratings in General Surgery: Patient Care and Systems-Based

Jonah D Thomas1, Claire Ferguson2, Shaghayegh Sabbaghan Kermani1

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

Journal of Surgical Education
|November 13, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

Program differences significantly impact general surgery resident ratings for patient care (PC) and systems-based practice (SBP) competencies. These variations, not solely resident performance, highlight the influence of training environments and rating practices.

Keywords:
clinical competency committeegeneral surgery traininggraduate medical educationmilestonesresidency trainingsurgical education

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Area of Science:

  • Medical Education Research
  • Surgical Training Assessment

Background:

  • The Accreditation Council for Graduate Medical Education (ACGME) Milestones 2.0 are crucial for assessing resident competency.
  • Understanding sources of variation in these ratings is essential for accurate evaluation.

Purpose of the Study:

  • To quantify program-level contributions to variability in general surgery resident ratings for patient care (PC) and systems-based practice (SBP) Milestones 2.0.

Main Methods:

  • Retrospective analysis of national ACGME Milestones 2.0 data (2020-2021) for 7581 general surgery residents across 328 U.S. programs.
  • Intraclass correlation coefficients (ICCs) were used to determine the extent of program-level variation in PC and SBP ratings across postgraduate years (PGY1-5).

Main Results:

  • Significant program-driven variation was found in all PC and SBP sub-competencies, particularly at PGY1 and PGY5 levels.
  • Program factors accounted for 38%-63% of variance in PC ratings and 45%-75% in SBP ratings.
  • The highest program influence was in SBP3 (Physician role in health care systems), ranging from 55% to 75%.

Conclusions:

  • A substantial portion of variation in PC and SBP Milestone ratings is attributable to program-level factors, not solely resident performance.
  • Differences in clinical competency committee practices, institutional culture, and training environments likely drive this variation.
  • Further research is needed to identify specific institutional practices influencing Milestone ratings.