Milestone Project: A Review of New Accreditation Council for Graduate Medical Education Next Accreditation System Milestones Evaluation System

by Jacqueline S. Israel, MD, Harry S. Nayar, MD, Nicole A. Phillips, MD and Joseph A. Ricci, MD

For most residency programs in the United States, the month of July holds certain significance, marking the transition of trainees between medical student and physician, between junior and senior resident, between resident and graduate. The reverberations of these transitions are often felt throughout the academic medical centers in which they take place. As such, July serves as an appropriate time to reflect upon the educational systems and policies currently in effect. This year, Plastic and Reconstructive Surgery dedicated a Special Topics section of the July issue to exactly this question, and the Resident Chronicles provide us with an excellent opportunity to continue the conversation. Our post focuses upon one of these articles: The New Accreditation Council for Graduate Medical Education Next Accreditation System Milestones Evaluation System: What is Expected and How Are Plastic Surgery Programs Preparing?

The authors begin with an excellent review of the history of the Accreditation Council for Graduate Medical Education (ACGME) and examine some of the previously implemented resident evaluation systems. Importantly, they describe some of the limitations of these prior evaluation systems, highlighting inconsistencies among programs with regards to both the definition of the core competencies as well as the methods for resident assessment.

As of 2013, the ACGME began to roll out the Milestones Evaluation System to evaluate residents in a more uniform manner. Defined as “competency-based developmental outcomes of core specialty-specific knowledge, skills, attitudes, and beliefs,” the Milestones were designed to measure expected resident progression from novice to “safe, competent, ethical physicians” (182). In order to standardize outcomes measures, the system was based off the Dreyfus model of expertise initially developed by the Air Force to evaluate pilots. The first phase of the Milestones system was initiated in July 2013 in seven specialties and adopted by plastic surgery programs in July 2014, one year ago.

The main focus of the article, however, are the results of a survey the authors conducted among plastic surgery residency programs, in order to determine the impact of the new Milestones system as they transition to using this new educational paradigm. Interestingly, while over 70 percent of responders thought that the milestones approach would improve the quality of resident training, only 22 percent reported feeling completely prepared for the use of the program, and only 23 percent were completely satisfied with their program’s planned approach for compliance. This suggests that while most plastic surgery educators agree with the conceptual design of the Milestones system, more work may be needed to ensure the consistency across training programs that the new system was designed to address.

As residents currently enrolled in plastic surgery training programs, we have experienced firsthand the unique methodologies being explored by individual programs for evaluating, reporting, and tracking competencies. One institution provided us with graphical representations of our evaluations, which resembled an array of radar imaging, each with its own subheading, smattered with shaded areas and outlines intended to illustrate our progress within the Milestone domains. Should we target the center, akin to a bulls-eye? Is the periphery the right place?  In what areas are we behind? Are we progressing as we should?  These were some of the questions that entered our minds on first encountering this new training paradigm.

Since the survey results—and our own experience—only reflect on the infancy of the Milestones program, significant changes will likely take place in the next several years as programs and residents become more familiar with Milestones. At this time, the Milestones program is poised to remedy many of the issues that arose with prior systems of resident evaluation and feedback. It is clear that in order for the Milestones system to become successful, significant investment is needed on the part of not only program administration but the residents as well.

The philosophy at the heart of the milestones project – namely, competency-based training – motivates and requires each of us to be more thoughtful of our own progress.  Identifying and exploring our deficiencies and strengths is becoming a multifaceted process that still incorporates, but is not limited to, our case logs. As Sillah and colleagues ask programs of their readiness for this new model, we find that we are asking the same of ourselves. We look forward to more studies outlining the development of this ambitious and exciting effort.


The New Accreditation Council for Graduate Medical Education Next Accreditation System Milestones Evaluation System: What Is Expected and How Are Plastic Surgery Residency Programs Preparing?
Sillah, Nyama M. M.D.; Ibrahim, Ahmed M. S. M.D., Ph.D.; Lau, Frank H. M.D.; Shah, Jinesh B.S.; Medin, Caroline B.S.; Lee, Bernard T. M.D., M.B.A.; Lin, Samuel J. M.D. Plastic & Reconstructive Surgery: July 2015 – Volume 136 – Issue 1 – p 181–187

July Issue of Plastic & Reconstructive Surgery

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