Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training

Journal of graduate medical education 09/2009; 1(1):5-20. DOI: 10.4300/01.01.0003
Source: PubMed


The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice.
In November 2007, the American Board of Internal Medicine (ABIM) and the ACGME initiated the development of milestones for internal medicine residency training. ABIM and ACGME convened a 33-member milestones task force made up of program directors, experts in evaluation and quality, and representatives of internal medicine stakeholder organizations. This article reports on the development process and the resulting list of proposed milestones for each ACGME competency.
The task force adopted the Dreyfus model of skill acquisition as a framework the internal medicine milestones, and calibrated the milestones with the expectation that residents achieve, at a minimum, the "competency" level in the 5-step progression by the completion of residency. The task force also developed general recommendations for strategies to evaluate the milestones.
The milestones resulting from this effort will promote competency-based resident education in internal medicine, and will allow program directors to track the progress of residents and inform decisions regarding promotion and readiness for independent practice. In addition, the milestones may guide curriculum development, suggest specific assessment strategies, provide benchmarks for resident self-directed assessment-seeking, and assist remediation by facilitating identification of specific deficits. Finally, by making explicit the profession's expectations for graduates and providing a degree of national standardization in evaluation, the milestones may improve public accountability for residency training.

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    • "A supervisor who can identify an appropriate learning task useful for patient care and provide relevant guidance can set the stage for skill development and eventually entrustment . Defined competencies and milestones can guide developmentally sequenced learning activities and assessments (Carraccio et al. 2002; Green et al. 2009) (Table 2). "
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    • "These resources do not specifically address communication with low HL patients. The ACGME has recently developed milestones for each of the competencies, including interpersonal and communication skills, but there are no milestones that specifically address communication with low HL patients (16). Programs that teach HL are appropriately focusing on communication skills found to be effective for low HL patients such as teach-back technique and using plain language (17). "
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    • "The latter goal, known as the ACGME's ''Outcome Project,'' is still in development with much research in progress to answer this call. Some specialties, (e.g., internal medicine, pediatrics), have organized training into milestones to better document how residents are progressing through training in regards to each competency (Green et al. 2009) and thus readiness to provide quality patient care. Specialties are also beginning to explore whether Entrustable Professional Activities (EPAs), those critical components of daily work that are the hallmark of the specialty, might provide an alternative way to synthesize ''competencies'' in a way that is more readily identifiable by faculty (Ten Cate & Scheele 2007). "
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