Milestones and You - AHME€¦ · Residents and Fellows •Increased transparency of performance...

Milestones and You

Laura Edgar, EdD, CAEVice President, Milestone Development

©2019 ACGME

• Full-time employee of ACGME

Disclosures

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• Milestones Background

• Milestones Structure

• Considerations for the Milestones in your program

• Milestones 2.0

Presentation Outline

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Milestones Background4

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• Describe performance levels for skills, knowledge, and behaviors in the six competency domains.

• Provide a framework of observable behaviors and attributes associated with residents’ development as physicians.

• Used as one indicator of a program’s educational progress

Milestones: What?

Nasca, TJ et. Al. The Next Accreditation System. 2012.366:1051-1056

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• What do they know?

• What can they do?

• How do they conduct themselves?

• Competencies must be in concert to demonstrate the competent graduate

Milestones – What?

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Purposes and Implications

ACGME

• Accreditation – continuous quality improvement (CQI)

• Public Accountability – focus nationally on important competency outcomes

• Community of practice for evaluation and research, with focus on continuous improvement

Training Programs

• Framework for CCC• Guide curriculum development• More explicit expectations of trainees• Support better assessment• Enhanced opportunities for early

identification of under-performers

High Stakes

• Research ONLY

• Not intended for SMB use

Residents and Fellows

• Increased transparency of performance requirements

• Encourage informed self-assessment and self-directed learning

• Better feedback• Facilitate individualized learning plans

Milestones

Milestones are a Formative Assessment Framework

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• Articulate shared understanding of expectations

• Describe trajectory from a beginner in the specialty to

an exceptional resident or practitioner

• Organized under six domains of clinical competency

• Represent a subset of all sub-competencies

• Set aspirational goals of excellence

Key Points: Milestones

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Milestones Structure9

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Milestone Template

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11

Milestone Template –

Osteopathic Recognition

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• 7 additional subcompetencies

• Evaluated in conjunction with the specialty specific milestones

• Only evaluated for Residents/Fellows in the Osteopathic Recognition Track

Osteopathic Recognition

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• Family Medicine (FM) Resident in the Osteopathic Recognition (OR) Track

• FM Patient Care 2: Cares for Patients with Chronic Conditions

• OR Patient Care 2: Examination, Diagnosis, and Treatment

• These can be evaluated simultaneously

• You may need to re-evaluate your assessment tools to ensure you are capturing appropriate Osteopathic principles

Osteopathic Recognition -

Example

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Option to select “Not Yet Completed Level 1” or “Not

Yet Assessable”

Milestones are progressive over time. There is no prescribed speed at which

residents must complete a milestone set.

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• An attempt to define an explicit, practical, relevant, and

manageable set of domains of clinical competence

• An attempt to describe levels of competency development

during training, leading to unsupervised practice of medicine

• A way to better inform trainees of the expectations of training

What the Milestones Are

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• Not everything a graduating resident needs to know

or be able to do

• Not a mandate for specific rotations or durations of

experience

• Not a replacement for regular assessment and

evaluation

What the Milestones are Not

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• Available resources: faculty time, evaluation forms

• Variations in engagement and attitudes within programs

• Learning curve: Evaluating, aggregating, and reporting become easier as you and your program become more familiar with the process

Milestones Considerations

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• All programs within a specialty use the specialty’s milestones

• Programs will report semi-annually

• Milestone data will be reported to ACGME through direct entry into the Accreditation Data System (ADS)

Milestones: Reporting

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• Residents/Fellows should receive a report of their

Milestones ratings following CCC meetings

• Ideally, residents/fellows perform self-evaluations

beforehand

Feedback to Residents and

Fellows

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• Coming Soon

Milestones 2.0

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Differences

Patient Care and Medical Knowledge have two options

outside of the levels:

• Not yet completed Level 1/Critical Deficiencies

• Not yet rotated/ Not yet assessable

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Supplemental Guide

Review the Milestones and Supplemental guide with

your CCC

Your CCC should do a shared mental model exercise

Program’s expectations at each level

Assessment tool(s) you will use

Rotations each will be assessed

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Assessment 101

Introduction to Milestones

Coming soon:

Milestones 2.0 webcasts

<10 minute webcast to explain 2.0 to faculty

Courses Available On Demand

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Milestones:

[email protected]

Laura Edgar

[email protected]

Here to help

mailto:[email protected]

mailto:[email protected]

Milestones and You - AHME€¦ · Residents and Fellows •Increased transparency of performance...

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