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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Available from: Eva M Aagaard, Sep 29, 2015
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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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    ABSTRACT: A third of Americans have low health literacy (HL). Research indicates a significant knowledge and skills gap among residents pertaining to management of patients with low HL. The objective of this study was to assess the teaching and evaluation methods around HL in community-based internal medicine residency programs. In addition, the study compared the teaching and evaluation practices used for doctor-patient communication skills to those used for HL skills. A structured questionnaire was completed by faculty of community-based internal medicine residency programs through the 'Community Hospital Education and Research Network' website and the Association of Program Directors in Internal Medicine community hospital assembly meeting in October 2011. Less than 50% of the programs provided any formal teaching on HL. HL was primarily taught via didactics (75%) followed by clinical observation (42%) and role-playing (25%). On the contrary, patient-provider communication skills were taught primarily using clinical observations (90%) and standardized patients (46.7%). The HL dimensions that programs focused on were the use of teach-back technique (100%), prevalence of low HL (83.3%), association between low HL and patient outcomes (83.3%), and use of plain language (83.3%). The areas that were least taught included helping patients navigate the health system (33.3%) and choosing effective written material for low HL patients (50%). Health literacy is not being taught consistently as part of the core curricula of the community-based internal medicine residency programs. There is a need for professional and technical resources to incorporate HL teaching in their curricula. There is a wide variation in terms of how HL skills are being taught and evaluated by community-based internal medicine residency programs.
    11/2012; 2(4). DOI:10.3402/jchimp.v2i4.19238
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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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