Background

The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice.

Intervention

In November 2007, the American Board of Internal Medicine (ABIM) and the ACGME initiated the development of milestones for internal medicine residency training. ABIM and ACGME convened a 33-member milestones task force made up of program directors, experts in evaluation and quality, and representatives of internal medicine stakeholder organizations. This article reports on the development process and the resulting list of proposed milestones for each ACGME competency.

Outcomes

The task force adopted the Dreyfus model of skill acquisition as a framework the internal medicine milestones, and calibrated the milestones with the expectation that residents achieve, at a minimum, the “competency” level in the 5-step progression by the completion of residency. The task force also developed general recommendations for strategies to evaluate the milestones.

Discussion

The milestones resulting from this effort will promote competency-based resident education in internal medicine, and will allow program directors to track the progress of residents and inform decisions regarding promotion and readiness for independent practice. In addition, the milestones may guide curriculum development, suggest specific assessment strategies, provide benchmarks for resident self-directed assessment-seeking, and assist remediation by facilitating identification of specific deficits. Finally, by making explicit the profession's expectations for graduates and providing a degree of national standardization in evaluation, the milestones may improve public accountability for residency training.

Background

Self-assessment is increasingly being incorporated into competency evaluation in residency training. Little research has investigated the characteristics of residents’ learning objectives and action plans after self-assessment.

Objective

To explore the frequency and specificity of residents’ learning objectives and action plans after completing either a highly or minimally structured self-assessment.

Design

Internal Medicine residents (N = 90) were randomized to complete a highly or minimally structured self-assessment instrument based on the Accreditation Council for Graduate Medical Education Core Competencies. All residents then identified learning objectives and action plans.

Measurements

Learning objectives and action plans were analyzed for content. Differences in specificity and content related to form, gender, and training level were assessed.

Results

Seventy-six residents (84% response rate) identified 178 learning objectives. Objectives were general (79%), most often focused on medical knowledge (40%), and were not related to the type of form completed (p > 0.01). “Reading more” was the most common action plan.

Conclusions

Residents commonly identify general learning objectives focusing on medical knowledge regardless of the structure of the self-assessment form. Tools and processes that further facilitate self-assessment should be identified.