Milestones on the Road to Competency: Advancing Competency-based Graduate Medical Education

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Milestones on the Road to Competency: Advancing Competency-based Graduate Medical Education ,[object Object],[object Object],[object Object],[object Object],[object Object],William F. Iobst MD 1 , Eric S. Holmboe MD 1 , Richard H. Bell, Jr. MD 2 , Sarah C. Hood MS 1 American Board of Internal Medicine 1 American Board of Surgery 2 INTERNAL MEDICINE MILESTONES Internal Medicine initially defined discrete developmental and behaviorally based milestones for each general competency (see Table 1) and is now piloting assessment strategies that bundle these milestones to allow evaluation of key developmental points in training called “landmarks” (see Figure 1). These landmarks represent critical stages in residency development that anticipate what have been described as entrustable professional activities (EPA) of the profession 1 . EPAs are activities that the public trusts all physicians are capable of performing. In the example shown in Figure 1, the ability to supervise a resident team is a critical stage in residency that anticipates the ultimate EPA of leading a health care team. ,[object Object],[object Object],[object Object],For additional information please contact: William F. Iobst, MD and Sarah C. Hood, MS Academic Affairs American Board of Internal Medicine [email_address] ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table 1: Example of Internal Medicine Milestone in the Patient Care General Competency 2 Figure 1: Example of Resident Team Supervision as an Entrustable Professional Activity (EPA) GENERAL SURGERY MILESTONES General Surgery elected to first identify critical domains of practice and then determine which of the broad ACGME general competencies were required in each domain. Within each domain, discreet milestones defining competency were subsequently developed. Ultimately, nine domains of practice were chosen (see Table 2). A domain like “consultation” for example requires demonstration of competency in medical knowledge, patient care, communications, and professionalism (see Figure 2). This construct is based on the fact that the professionalism required for consultation is related to, but not the same as the professionalism required to complete administrative tasks. By evaluating competence in context, as in the consultation example, the assessment and evaluation of the general competencies can be focused on discrete milestones. Table 2: The Nine Domains of Practice for General Surgery Figure 2: Competence in the Context of Providing Consultation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PC, PROF, COMM, SBP Does administrative tasks PROF Maintains personal health PC, PROF, COMM Educates PC, COMM, SBP, PBL Improves care MK, PROF, PBL Engages in self directed learning MK, PC, COMM, SBP Coordinate care MK, PC, PROF, COMM, Provide consultation MK, PC, PROF, COMM, SBP, PBL Perform operations and procedures MK, PC, PROF, COMM, SBP, PBL Care for diseases and conditions Domains of Competency Required Domains of Practice

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