The Thoracic Surgery Milestone Project

Online Publication Date: 01 Mar 2014
Page Range: 332 – 354
DOI: 10.4300/JGME-06-01s1-13
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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.

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 a 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. Please note that residents in a traditional program may start at a higher level for many of the Milestones due to their previous experience within the general surgery program.

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 which 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.

Additional Notes

Level 4 is designed as the graduation target and 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.

To aid in evaluating the Milestone levels, various assessment tools were also developed. Use of these tools is not required.

Some Milestone descriptions include statements about performing independently. These activities must occur in conformity to 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. Answers to Frequently Asked Questions about the NAS and Milestones are available on the ACGME's website.

ACGME Milestone Report Form

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

  • 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 Milestones, selecting the option that says the resident has “Not yet achieved Level 1.”

FIGURE. Example Set of Milestones for 1 Subcompetency in the ACGME Milestone Report FormFIGURE. Example Set of Milestones for 1 Subcompetency in the ACGME Milestone Report FormFIGURE. Example Set of Milestones for 1 Subcompetency in the ACGME Milestone Report Form
FIGURE Example Set of Milestones for 1 Subcompetency in the ACGME Milestone Report Form

Citation: Journal of Graduate Medical Education 6, 1s1; 10.4300/JGME-06-01s1-13

THORACIC SURGERY MILESTONES

TABLE 1 Ischemic Heart Disease—Patient Care and Technical Skills 1
TABLE 1
TABLE 2 Ischemic Heart Disease—Medical Knowledge 1
TABLE 2
TABLE 3 Cardiopulmonary Bypass, Myocardial Protection, and Temporary Circulatory Support—Patient Care and Technical Skills 2
TABLE 3
TABLE 4 Cardiopulmonary Bypass, Myocardial Protection, and Temporary Circulatory Support—Medical Knowledge 2
TABLE 4
TABLE 5 Valvular Disease—Patient Care and Technical Skills 3
TABLE 5
TABLE 6 Valvular Disease—Medical Knowledge 3
TABLE 6
TABLE 7 Great Vessel Disease—Patient Care and Technical Skills 4
TABLE 7
TABLE 8 Congenital Heart Disease—Medical Knowledge 4
TABLE 8
TABLE 9 Esophagus—Patient Care and Technical Skills 5
TABLE 9
TABLE 10 Esophagus—Medical Knowledge 5
TABLE 10
TABLE 11 Lung and Airway—Patient Care and Technical Skills 6
TABLE 11
TABLE 12 Lung and Airway—Medical Knowledge 6
TABLE 12
TABLE 13 Chest Wall/Pleura/Mediastinum—Patient Care and Technical Skills 7
TABLE 13
TABLE 14 Chest Wall/Pleura/Mediastinum—Medical Knowledge 7
TABLE 14
TABLE 15 Critical Care—Patient Care and Technical Skills 8
TABLE 15
TABLE 16 Critical Care—Medical Knowledge 8
TABLE 16
TABLE 17 End-Stage Cardiopulmonary Disease—Medical Knowledge 9
TABLE 17
TABLE 18 Patient Safety—Systems-Based Practice 1
TABLE 18
TABLE 19 Resource Allocation—Systems-Based Practice 2
TABLE 19
TABLE 20 Practice Management—Systems-Based Practice 3
TABLE 20
TABLE 21 The Ability to Investigate and Evaluate the Care of Patients, to Appraise and Assimilate Scientific Evidence, and to Continuously Improve Patient Care Based on Constant Self-Evaluation, Evidence-Based Guidelines and Lifelong Learning—Practice-Based Learning and Improvement 1
TABLE 21
TABLE 22 Research and Teaching—Practice-Based Learning and Improvement 2
TABLE 22
TABLE 23 Ethics and Values—Professionalism 1
TABLE 23
TABLE 24 Personal Accountability—Professionalism 2
TABLE 24
TABLE 25 Interpersonal and Communication Skills
TABLE 25
Copyright: Copyright © 2013 Accreditation Council for Graduate Medical Education and American Board of Thoracic Surgery. All rights reserved. The copyright owners grant third parties the right to use the Colon and Rectal Surgery Milestones on a nonexclusive basis for educational purposes. 2014
FIGURE
FIGURE

Example Set of Milestones for 1 Subcompetency in the ACGME Milestone Report Form

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