Critical Care Anesthesiology Milestones 2.0: A Framework for Competency Assessment in Subspecialty Fellowship

The Accreditation Council for Graduate Medical Education (ACGME) introduced Milestones in 2013 to aid the assessment of residents and fellows within the framework of the six core competencies of practice. Feedback from program directors and trainees, clinical competency committee processes, and milestone reporting identified the need for modification. This study represents a consensus-driven educational quality improvement initiative which describes the development, revision process, and key features of Critical Care Anesthesiology (CCA) Milestones 2.0, and provides lessons learned in adapting competency-based assessment to a one-year subspecialty training program.

A Critical Care Anesthesiology (CCA) working group was convened by the ACGME in 2021 to revise the content, enhance relevance to training, clarify goals for program leadership, and develop supplemental resources to aid implementation. The group consisted of a diverse group of experienced educators and clinicians from CCA fellowship programs nationwide. A modified Delphi process, stakeholder feedback, Milestones performance data, and public comment were used to iteratively revise Milestones. In addition, a supplemental guide was developed to provide examples and resources to aid the Milestones assessment.

The Milestones 2.0 simplify the use, implementation, and interpretation of this competency framework for program directors, trainees, faculty, and the American Board of Anesthesiology. The resulting CCA Milestones 2.0 provide updated specialty-specific, competency-based behavioral anchors to guide the developmental progression of competencies and outcomes for CCA fellows and facilitate the design of curricula and the advancement of CCA training programs. Lessons learned in the development of the CCA Milestones 2.0 include the importance of simplification, behavioral specificity, and supplemental.