The Obstetrics and Gynecology Milestone Project

The Milestones provide a framework for the assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. The Milestones are designed only for use in evaluation of resident physicians in the context of their participation in Accreditation Council for Graduate Medical Education (ACGME)–accredited residency or fellowship programs. They neither represent the entirety of the dimensions of the 6 domains of physician competency, nor are they designed to be relevant in any other context.

The authors, all of whom participated in Milestone development as members of the Obstetrics and Gynecology Milestone Working Group, wish to thank the members of the Obstetrics and Gynecology Framing Group for their contributions to this work: Haywood L. Brown, MD; Tamara T. Chao, MD; Missy Fleming, PhD; Diane Hartmann, MD; Frank Ling, MD; Krista Reagan, MD; Jeffrey M. Rothenberg, MD; Andrew Satin, MD; Howard Shaw, MD; David Soper, MD; Ronald C. Strickler, MD; and Susan Swing, PhD.

Milestone Reporting

This document presents Milestones designed for programs to use in semiannual review of resident performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for resident performance as a resident moves from entry into residency through graduation. In the initial years of implementation, the Review Committee will examine Milestone performance data for each program's residents as 1 element in the Next Accreditation System (NAS) to determine whether residents overall are progressing.

For each period, review and reporting will involve selecting Milestone levels that best describe each resident's current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert. These levels do not correspond with postgraduate year of education. Selection of a level implies that the resident substantially demonstrates the Milestones in that level, as well as those in lower levels (see figure).

• Level 1: The resident demonstrates Milestones expected of an incoming resident.

• Level 2: The resident is advancing and demonstrates additional Milestones, but is not yet performing at a midresidency level.

• Level 3: The resident continues to advance and demonstrate additional Milestones, consistently including the majority of Milestones targeted for residency.

• Level 4: The resident has advanced so that he or she now substantially demonstrates the Milestones targeted for residency. This level is designed as the graduation target.

• Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating aspirational goals that might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this level.

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Additional Notes

Level 4 is designed as the graduation target but does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the residency program director. Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether Milestones in the first 4 levels appropriately represent the developmental framework and whether Milestone data are of sufficient quality to be used for high-stakes decisions.

Examples are provided with some Milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element.

Some Milestone descriptions include statements about performing independently. These activities must occur in conformity with the ACGME supervision guidelines as well as institutional and program policies. For example, a resident who performs a procedure independently must, at a minimum, be supervised through oversight.

ACGME Milestone Report Form

The figure presents an example set of Milestones for 1 subcompetency in the same format as the ACGME Milestone Report Form. For each reporting period, a resident's performance on the Milestones for each subcompetency will be indicated by 1 of the following:

• Selecting the level of Milestones that best describes that resident's performance in relation to the Milestones, or

• For Patient Care and Medical Knowledge Milestones, selecting the option that says the resident has “not yet rotated,” or

• For Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice, selecting the option that says the resident has “Not Yet Achieved Level 1.”

OBSTETRICS MILESTONES

TABLE 1 Antepartum Care and Complications of Pregnancy—Patient Care 1

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TABLE 2 Care of Patients in the Intrapartum Period—Patient Care 2

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TABLE 3 Care of Patients in the Postpartum Period—Patient Care 3

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TABLE 4 Obstetrical Technical Skills—Patient Care 4

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TABLE 5 Immediate Care of the Newborn—Patient Care 5

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GYNECOLOGY MILESTONES

TABLE 6 Gynecology Technical Skills: Laparotomy (eg, Hysterectomy, Myomectomy, Adnexectomy)—Patient Care 6

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TABLE 7 Gynecology Technical Skills: Vaginal Surgery (eg, Vaginal Hysterectomy, Colporrhaphy, Mid-urethral Sling)—Patient Care 7

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TABLE 8 Gynecology Technical Skills: Endoscopy (Laparoscopy, Hysteroscopy, Cystoscopy)—Patient Care 8

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TABLE 9 Perioperative Care—Medical Knowledge 1

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TABLE 10 Abdominal/Pelvic Pain (Acute and Chronic)—Medical Knowledge 2

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TABLE 11 Abnormal Uterine Bleeding (Acute and Chronic)—Medical Knowledge 3

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TABLE 12 Pelvic Mass—Medical Knowledge 4

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TABLE 13 Pelvic Floor Disorders (Urinary Incontinence, Pelvic Prolapse, Anal Incontinence)—Medical Knowledge 5

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TABLE 14 First-Trimester Bleeding—Medical Knowledge 6

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OFFICE PRACTICE MILESTONES

TABLE 15 Family Planning—Patient Care 9

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TABLE 16 Ambulatory Gynecology—Patient Care 10

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TABLE 17 Care of the Patient With Nonreproductive Medical Disorders—Patient Care 11

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MEDICAL KNOWLEDGE

TABLE 18 Health Care Maintenance and Disease Prevention—Medical Knowledge 7

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SYSTEMS-BASED PRACTICE MILESTONES

TABLE 19 Patient Safety and Systems Approach to Medical Errors: Participate in Identifying System Errors and Implementing Potential Systems Solutions—Systems-Based Practice 1

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TABLE 20 Cost-Effective Care and Patient Advocacy—Systems-Based Practice 2

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PRACTICE-BASED LEARNING AND IMPROVEMENT MILESTONES

TABLE 21 Self-Directed Learning/Critical Appraisal of Medical Literature—Practice-Based Learning and Improvement 1

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TABLE 22 Quality Improvement Process: Systematically Analyze Practice Using Quality Improvement (QI) Methods and Implement Changes With the Goal of Practice Improvement—Practice-Based Learning and Improvement 2

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PROFESSIONALISM MILESTONES

TABLE 23 Compassion, Integrity, and Respect for Others—Professionalism 1

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TABLE 24 Accountability and Responsiveness to the Needs of Patients, Society, and the Profession—Professionalism 2

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TABLE 25 Respect for Patient Privacy, Autonomy, Patient-Physician Relationship—Professionalism 3

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INTERPERSONAL AND COMMUNICATION SKILLS MILESTONES

TABLE 26 Communication With Patients and Families—Interpersonal and Communication Skills 1

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TABLE 27 Communication With Physicians and Other Health Professionals and Teamwork—Interpersonal and Communication Skills 2

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TABLE 28 Informed Consent and Shared Decision Making—Interpersonal and Communication Skills 3

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