Track residents' progress with Milestones

Residency Program Insider, July 12, 2019

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Editor’s Note: The following is an excerpt from Clinical Competency Committees Made Simple. For more information about this book, click here.

Programs have historically evaluated trainees on the ACGME six core competencies and will continue to do so, but in a more robust way with the addition of Milestones. Milestones can be thought of as competency outcomes that provide more details to aid in effective curriculum development to meet board requirements. 

Prior to implementation of the Milestones, many programs used Likert-scale evaluations. Whether you used a 1–5 or 1–10 scale, chances are that most residents were rated highly. If you were a great post graduate year (PGY)-1 resident, you may have achieved a 4 or a 5 on a 1–5 Likert scale. However, the Milestones measure progress differently. For example, someone rated a 5 would be considered an expert, capable of independent practice. Is a PGY-1 capable of independent practice? Most likely not. Regardless of how fantastic a PGY-1 may be, he or she is functioning at the level of someone who is acquiring a skillset.

Those old numerical ratings really did not explain how a resident was progressing, nor did they prove what competency level was achieved. More often than not, there were few comments in the evaluation that the resident could use constructively to better him or herself. The resident was not given feedback on his or her abilities; it was simply a grade. In contrast, Milestones tell residents where they rate in specific, measurable areas. They allow residents to track their progress over time and to identify strengths as well as weaknesses upon which they may want to improve.

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