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Transition between Residency and Fellowship: A National Study of the Longitudinal Alignment between ACGME Milestones
Tawni M Johnston1,2, Sean O Hogan1,3, Martha Libby Weaver4,5
1Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA.
Objective:
To understand residency to fellowship transition by exploring the alignment of graduating general surgery (GS) residency and early vascular surgery fellowship (VSF) ACGME Milestones 2.0 competencies.
Background:
Milestones 2.0 presents an opportunity to evaluate trainee progression from residency through fellowship. Understanding the residency-fellowship alignment of Milestones ratings is important for the training continuum and identifying early signals for struggling learners during this transition.
Methods:
This is a retrospective national study of two VSF cohorts (starting 2022 and 2023) who previously completed GS residency. We compared ACGME Milestones 2.0 ratings from the final 2 years of residency to year-1 VSF using descriptive statistics and linear mixed effects regression models.
Results:
Milestones data were collected for vascular surgery fellows ( n =266). Results showed significant PGY-5 GS-VSF predictive alignment for PC (β=0.20, P =0.004); MK (β=0.13, P =0.027); PROF (β=0.23, P <0.001); and ICS (β=0.17, P =0.01). These results translate to a mean fellowship Milestones level difference between learners up to 0.49 to 0.64 units for every 1-unit difference in Milestones between GS residents. SBP and PBLI ratings were not significantly aligned. Matched subcompetencies showed significant alignment (3 of 4 PC, 2 of 2 MK, 4 of 4 PROF, 2 of 3 ICS).
Conclusions:
The alignment between graduating GS residents and VSF year-1 Milestones ratings for PC, MK, PROF, and ICS demonstrates a continuum in educational outcomes and potential use to facilitate the residency-fellowship transition. These findings may support using Milestones 2.0 for residency-fellowship hand-off and performance analytics that may serve as early feedback to support trainees.
