Special Article
Specialty Milestones and the Next Accreditation System: An Opportunity for the Simulation Community Michael S. Beeson, MD, MBA; John A. Vozenilek, MD
Summary Statement: The Accreditation for Graduate Medical Education has developed a new process of accreditation, the Next Accreditation System (NAS), which focuses on outcomes. A key component of the NAS is specialty milestonesVspecific behavior, attributes, or outcomes within the general competency domains. Milestones will mark a level of proficiency of a resident within a competency domain. Each specialty has developed its own set of milestones, with semiannual reporting to begin July 2013, for 7 specialties, and the rest in July 2014. Milestone assessment must be based on objective data. Each specialty will determine optimal methods of measuring milestones, based on ease, cost, validity, and reliability. The simulation community has focused many graduate medical education efforts at training and formative assessment. Milestone assessment represents an opportunity for simulation modalities to offer summative assessment of milestone proficiencies, adding to the potential methods that residency programs will likely use or adapt. This article discusses the NAS, milestone assessment, and the opportunity to the simulation community to become involved in this next stage of graduate medical education assessment. (Sim Healthcare 9:184Y191, 2014)
Key Words: Milestones, Resident assessment, Competency assessment
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he Accreditation for Graduate Medical Education (ACGME) and the specialty boards of the American Board of Medical Specialties (ABMS) have cooperated to define and develop resident education milestones for each specialty. These milestones are defined as specific behaviors, attributes, or outcomes in the general competency domains to be demonstrated by residents at a particular point during the residency education. The milestones are outgrowths of the Outcome Project,1 in which 6 core competencies were defined (patient care, medical knowledge, professionalism, interpersonal and communication skills, systems-based practice, and practice-based learning and improvement). The milestones for each medical specialty represent outcome measures (ie, milestones of competency development) to be used as evidence of residency programs’ educational effectiveness and
a measure of a resident’s level of proficiency within any given milestone subcompetency. Procedural skills, often referred to as ‘‘technical’’ skills, have been folded into the patient care domain. Milestones are the cornerstone of the ACGME’s Next Accreditation System (NAS), in which the focus is on outcomes. It is unclear which of multiple assessment methods may be most appropriate for specific milestones and their competency domains. Many may be amenable to assessment using simulation and its related modalities, including computer-based clinical environment modeling, standardized patients, task trainers, and various hybrid models. The simulation community may be in a unique position to develop a role in the development of tools for the assessment of specialty milestones.
From the Akron General Medical Center (M.S.B.), Northeast Ohio Medical University, Akron, OH; and Jump Trading Simulation and Education Center (J.A.V.), OSF Healthcare, University of Illinois College of Medicine, Peoria, IL. Reprints: Michael S. Beeson, MD, MBA, Akron General Medical Center, Northeast Ohio Medical University, 400 Wabash Ave, Akron, OH 44307 (e
Specialty Milestones and the Next Accreditation System: An Opportunity for the Simulation Community Michael S. Beeson, MD, MBA; John A. Vozenilek, MD
Summary Statement: The Accreditation for Graduate Medical Education has developed a new process of accreditation, the Next Accreditation System (NAS), which focuses on outcomes. A key component of the NAS is specialty milestonesVspecific behavior, attributes, or outcomes within the general competency domains. Milestones will mark a level of proficiency of a resident within a competency domain. Each specialty has developed its own set of milestones, with semiannual reporting to begin July 2013, for 7 specialties, and the rest in July 2014. Milestone assessment must be based on objective data. Each specialty will determine optimal methods of measuring milestones, based on ease, cost, validity, and reliability. The simulation community has focused many graduate medical education efforts at training and formative assessment. Milestone assessment represents an opportunity for simulation modalities to offer summative assessment of milestone proficiencies, adding to the potential methods that residency programs will likely use or adapt. This article discusses the NAS, milestone assessment, and the opportunity to the simulation community to become involved in this next stage of graduate medical education assessment. (Sim Healthcare 9:184Y191, 2014)
Key Words: Milestones, Resident assessment, Competency assessment
T
he Accreditation for Graduate Medical Education (ACGME) and the specialty boards of the American Board of Medical Specialties (ABMS) have cooperated to define and develop resident education milestones for each specialty. These milestones are defined as specific behaviors, attributes, or outcomes in the general competency domains to be demonstrated by residents at a particular point during the residency education. The milestones are outgrowths of the Outcome Project,1 in which 6 core competencies were defined (patient care, medical knowledge, professionalism, interpersonal and communication skills, systems-based practice, and practice-based learning and improvement). The milestones for each medical specialty represent outcome measures (ie, milestones of competency development) to be used as evidence of residency programs’ educational effectiveness and
a measure of a resident’s level of proficiency within any given milestone subcompetency. Procedural skills, often referred to as ‘‘technical’’ skills, have been folded into the patient care domain. Milestones are the cornerstone of the ACGME’s Next Accreditation System (NAS), in which the focus is on outcomes. It is unclear which of multiple assessment methods may be most appropriate for specific milestones and their competency domains. Many may be amenable to assessment using simulation and its related modalities, including computer-based clinical environment modeling, standardized patients, task trainers, and various hybrid models. The simulation community may be in a unique position to develop a role in the development of tools for the assessment of specialty milestones.
From the Akron General Medical Center (M.S.B.), Northeast Ohio Medical University, Akron, OH; and Jump Trading Simulation and Education Center (J.A.V.), OSF Healthcare, University of Illinois College of Medicine, Peoria, IL. Reprints: Michael S. Beeson, MD, MBA, Akron General Medical Center, Northeast Ohio Medical University, 400 Wabash Ave, Akron, OH 44307 (e
