The Dermatology Milestone Project

Online Publication Date: 01 Mar 2014
Page Range: 47 – 70
DOI: 10.4300/JGME-06-01s1-03
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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 reporting period, review and reporting will involve selecting the level of Milestones that best describes each resident's current performance level in relation to Milestones. Milestones are arranged into numbered levels. Selection of a level implies that the resident substantially demonstrates the Milestones in that level, as well as those in lower levels (figure). A general interpretation of levels for the Dermatology Milestones is below.

  • Level 1: The resident demonstrates Milestones expected of an incoming or early beginning resident who has had some education in dermatology.

  • Level 2: The resident is advancing and demonstrating additional Milestones.

  • Level 3: The resident continues to advance and is demonstrating additional Milestones; the resident consistently demonstrates most 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 but does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the residency program director (see the NAS Frequently Asked Questions for educational Milestones on the ACGME's website for further discussion of this issue: “Can a resident graduate if he or she does not reach every Milestone?”). Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether Level 4 Milestones and Milestones in lower levels are in the appropriate level within the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions.

Some Milestone descriptions include statements about performing independently. These activities must follow the ACGME supervision guidelines. For example, a resident who performs a procedure or takes independent call 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:

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

  • selecting the “Has Not Achieved Level 1” option.

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-06-01s1-03

DERMATOLOGY MILESTONES - Patient Care (PC)

TABLE 1 PC1. History, Examination, and Presentation
TABLE 1
TABLE 2 PC2. Diagnostic Tests
TABLE 2
TABLE 3 PC3. Dermatopathology Application
TABLE 3
TABLE 4 PC4. Medical Treatment
TABLE 4
TABLE 5 PC5. Pediatric Treatment
TABLE 5
TABLE 6 PC6. Surgical Treatment
TABLE 6
TABLE 7 PC7. Diagnosis, Management Decisions, and Patient Education
TABLE 7

Medical Knowledge (MK)

TABLE 8 MK1. Medical Dermatology
TABLE 8
TABLE 9 MK2. Pediatric Dermatology
TABLE 9
TABLE 10 MK3. Dermatologic Surgery
TABLE 10
TABLE 11 MK4. Dermatopathology
TABLE 11
TABLE 12 MK5. Application of Basic Science Knowledge to Clinical Care
TABLE 12

Systems-Based Practice (SBP)

TABLE 13 SBP1. Adapts Easily and Works Effectively in Various Health Care Delivery Settings and Systems
TABLE 13
TABLE 14 SBP2. Works Effectively Within an Interprofessional Team
TABLE 14
TABLE 15 SBP3. Improves Health Care Delivery by Identifying Systems Errors and Implementing Potential Systems Solutions; Advocates for Quality Patient Care and Optimal Patient Care Systems
TABLE 15
TABLE 16 SBP4. Practices Cost-Conscious Care (For Patients and Populations)
TABLE 16

Practice-Based Learning and Improvement (PBLI)

TABLE 17 PBLI1. Appraise and Assimilate Scientific Evidence
TABLE 17
TABLE 18 PBLI2. Continuously Improve Through Self-Assessment of Competence
TABLE 18
TABLE 19 PBLI3. Integrate Quality Improvement Concepts and Activities in Practice
TABLE 19
TABLE 20 PBLI4. Teach Others
TABLE 20

Professionalism (PROF)

TABLE 21 PROF1. Practices Medicine Ethically
TABLE 21
TABLE 22 PROF2. Committed to Lifelong Learning and Improvement
TABLE 22
TABLE 23 PROF3. Patient Care Is the First Priority
TABLE 23

Interpersonal and Communication Skills (ICS)

TABLE 24 ICS1. Communication and Rapport with Patients and Families
TABLE 24
TABLE 25 ICS2. Having Difficult Conversations
TABLE 25
TABLE 26 ICS3. Team Member Respect and Care Coordination
TABLE 26
TABLE 27 ICS4. Communication and Consultation With Other Physicians
TABLE 27
TABLE 28 ICS5. Medical Documentation
TABLE 28
Copyright: Copyright © 2013 Accreditation Council for Graduate Medical Education and American Board of Dermatology. 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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