Q: What are milestones and how will I use them in my programs?
A: Milestones are observable developmental steps as a resident moves from a novice to a master and are based on the six domains of competency. They are specific to each specialty and have either been determined or are in process of being determined for each specialty. Milestones will be one of the program performance indicators for programs within the Next Accreditation System (NAS). They will be required for each resident and the information will be submitted to the ACGME every six months. It is important to note that milestones do not replace the current evaluation methods that you use to evaluate your residents (i.e. global evaluations, multi-source evaluations, direct observation, etc.). Milestones are to be used in conjunction with your current evaluation methods.
Determine if your specialty has published milestones: Milestones have been published for the first seven RRC’s that entered NAS in July 2013. You can view them here: http://www.acgme-nas.org/milestones.html. If your specialty has not published milestones yet, it is a good idea to take a look at some of the other specialties to get an idea of what you can expect.
Review and understand the milestones for your specialty: It is important that you know and understand the milestones for your specialty. Read them carefully and begin to think of ways that you can assess each one for your residents. As your specialty milestones are finalized, begin incorporating them into your curriculum. Seek out specialty support for clarification if you do not understand a milestone or are not clear on the expectation.
Perform some practice runs using the milestones: Practice using the milestones with your faculty and residents. Set aside time in your residency program meetings to review the milestones and begin thinking of assessment methods that you will use for each one. As program directors, you will ultimately be responsible for identifying the level of milestone that you are targeting for each level of training. By discussing with your faculty and practicing using the milestones, you will be well prepared for when the time comes to officially be using them in your program.