Karen E. Hauer, MD, PhD; Jerome Clauser, EdD; Rebecca S. Lipner, PhD; Eric S. Holmboe, MD; Kelly Caverzagie, MD; Stanley J. Hamstra, PhD; Sarah Hood, MS; William Iobst, MD; Eric Warm, MD; Furman S. McDonald, MD, MPH
Disclosures: Dr. Hauer reports that she received consulting fees to work with the ABIM on the preparation of this analysis and manuscript. Dr. Lipner reports employment at the ABIM. Dr. Holmboe reports royalties from Mosby-Elsevier and employment with the ACGME outside the submitted work and membership on the board of the National Board of Medical Examiners. Dr. Iobst reports that he led the milestones writing group that developed the IM milestones while he was employed at the ABIM. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2411.
Requests for Single Reprints: Karen E. Hauer, MD, PhD, University of California, San Francisco, 533 Parnassus Avenue, U80, Box 0710, San Francisco, CA 94143; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Hauer: Professor of Medicine, University of California, San Francisco, 533 Parnassus Avenue, U80, Box 0710, San Francisco, CA 94143.
Dr. Clauser: Research Psychometrician, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.
Dr. Lipner: Senior Vice President for Assessment and Research, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.
Dr. Holmboe: Senior Vice President, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, 515 North State Street, Chicago, IL 60654.
Dr. Caverzagie: Associate Professor of Internal Medicine, University of Nebraska College of Medicine, 986430 Nebraska Medical Center, Omaha, NE 68114.
Dr. Hamstra: Vice-President, Milestone Research and Evaluation, Accreditation Council for Graduate Medical Education, 515 North State Street, Suite 2000, Chicago, IL 60654.
Ms. Hood: Director of Initial Certification, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.
Dr. Iobst: Vice Dean, Vice President for Academic and Clinical Affairs, The Commonwealth Medical College, 525 Pine Street, Scranton, PA 18509.
Dr. Warm: Professor of Medicine, University of Cincinnati, 234 Albert Sabin Way, M.L. 0557, Cincinnati, OH 45267-0557.
Dr. McDonald: Senior Vice President for Academic and Medical Affairs, Professor of Medicine, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.
Author Contributions: Conception and design: K.E. Hauer, J. Clauser, R.S. Lipner, E.S. Holmboe, S. Hood, F.S. McDonald.
Analysis and interpretation of the data: K.E. Hauer, J. Clauser, R.S. Lipner, E.S. Holmboe, K. Caverzagie, S.J. Hamstra, S. Hood, W. Iobst, E. Warm, F.S. McDonald.
Drafting of the article: K.E. Hauer.
Critical revision of the article for important intellectual content: K.E. Hauer, R.S. Lipner, E.S. Holmboe, K. Caverzagie, S.J. Hamstra, S. Hood, W. Iobst, E. Warm, F.S. McDonald.
Final approval of the article: K.E. Hauer, J. Clauser, R.S. Lipner, E.S. Holmboe, K. Caverzagie, S.J. Hamstra, S. Hood, W. Iobst, E. Warm, F.S. McDonald.
Provision of study materials or patients: R.S. Lipner, F.S. McDonald.
Statistical expertise: J. Clauser, R.S. Lipner, S.J. Hamstra.
Administrative, technical, or logistic support: K. Caverzagie, S. Hood, F.S. McDonald.
Collection and assembly of data: J. Clauser, R.S. Lipner, E.S. Holmboe, F.S. McDonald.
High-quality assessment of resident performance is needed to guide individual residents' development and ensure their preparedness to provide patient care. To facilitate this aim, reporting milestones are now required across all internal medicine (IM) residency programs.
To describe initial milestone ratings for the population of IM residents by IM residency programs.
IM residency programs.
All IM residents whose residency program directors submitted milestone data at the end of the 2013–2014 academic year.
Ratings addressed 6 competencies and 22 subcompetencies. A rating of “not assessable” indicated insufficient information to evaluate the given subcompetency. Descriptive statistics were calculated to describe ratings across competencies and training years.
Data were available for all 21 774 U.S. IM residents from all 383 programs. Overall, 2889 residents (1621 in postgraduate year 1 [PGY-1], 902 in PGY-2, and 366 in PGY-3) had at least 1 subcompetency rated as not assessable. Summaries of average ratings by competency and training year showed higher ratings for PGY-3 residents in all competencies. Overall ratings for each of the 6 individual competencies showed that fewer than 1% of third-year residents were rated as “unsatisfactory” or “conditional on improvement.” However, when subcompetency milestone ratings were used, 861 residents (12.8%) who successfully completed training had at least 1 competency with all corresponding subcompetencies graded below the threshold of “readiness for unsupervised practice.”
Data were derived from a point in time in the first reporting period in which milestones were used.
The initial milestone-based evaluations of IM residents nationally suggest that documenting developmental progression of competency is possible over training years. Subcompetencies may identify areas in which residents might benefit from additional feedback and experience. Future work is needed to explore how milestones are used to support residents' development and enhance residency curricula.
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Hauer KE, Clauser J, Lipner RS, Holmboe ES, Caverzagie K, Hamstra SJ, et al. The Internal Medicine Reporting Milestones: Cross-sectional Description of Initial Implementation in U.S. Residency Programs. Ann Intern Med. 2016;165:356-362. doi: 10.7326/M15-2411
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Published: Ann Intern Med. 2016;165(5):356-362.
Published at www.annals.org on 10 May 2016
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