The Psychiatry Milestones 2.0: How Did We Get from 1.0 to 2.0 and What Can Users Expect?

Macaluso, Matthew; Kinzie, Mark; Cowley, Deborah S.; Houston, Lillian J.; DeJong, Sandra M.; Janssen, Furhut; Bentman, Adrienne; Edgar, Laura; Campbell, Brittany Doreen; Bowen, Lynneice; Aronowitz, Jeffery; Aoun, Elie; Santiago, Patcho N.; Keepers, George A.

doi:10.1007/s40596-020-01275-0

Cited by 12 publications

(6 citation statements)

References 14 publications

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“…8 In addition, some of the SCs, particularly in the areas of professionalism and interpersonal and communication skills, focus on innate behaviors that are more difficult to teach and more difficult to measure such as emotional intelligence, resilience, self-awareness, and self-motivation. Revised ACGME milestone language (Milestone 2.0) 16,17 will be released in 2022 and should help to address some of these issues. The ability to correlate target milestone levels to success in independent clinical practice would allow for establishment of more definitive graduation benchmarks for PDs.…”

Section: Discussionmentioning

confidence: 99%

Pediatric emergency medicine fellows’ milestone evaluations: Do they all meet the targets for graduation?

Roskind

Leonard

Baghdassarian

et al. 2021

AEM Education and Training

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Background:The ACGME Milestone Project created a competency-based trainee assessment tool. Subcompetencies (SCs) are scored on a 5-point scale; level 4 is recommended for graduation. The 2018 Milestones Report found that across subspecialties, not all graduates attain level 4 for every SC. Objective: The objective was to describe the number of pediatric emergency medicine (PEM) fellows who achieve ≥ level 4 in all 23 SCs at graduation and identify SCs where level 4 is not achieved and factors predictive of not achieving a level 4. Methods: This is a multicenter, retrospective cohort study of PEM fellows from 2014 to 2018. Program directors provided milestone reports. Descriptive analysis of SC scores was performed. Subanalyses assessed differences in residency graduation scores, first-year fellowship scores, and the rate of milestone attainment between fellows who did and did not attain ≥ level 4 at graduation.Results: Data from 392 fellows were obtained. There were no SCs in which all fellows attained ≥ level 4 at graduation; the range of fellows scoring < level 4 per SC was 7% to 39%. A total of 67% of fellows did not attain ≥ level 4 on one or more SC. While some fellows failed to attain ≥ level 4 on up to all 23 SCs, 26% failed to meet level 4 on only one or two. In 19 SCs, residency graduation and/or first year fellow scores were lower for fellows who did not attain ≥ level 4 at graduation compared to those who did (mean difference = 0.74 points). Among 10 SCs, fellows who did not attain ≥ level 4 at graduation had a faster rate of improvement compared to those who did attain ≥ level 4. Conclusion:In our sample, 67% of PEM fellows did not attain level 4 for one or more of the SCs at graduation. Low scores during residency or early in fellowship may predict difficulty in meeting level 4 by fellowship completion.

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Section: Discussionmentioning

confidence: 99%

Pediatric emergency medicine fellows’ milestone evaluations: Do they all meet the targets for graduation?

Roskind

Leonard

Baghdassarian

et al. 2021

AEM Education and Training

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“…While the working group made efforts to write from an equity lens, these versions of Milestones 2.0 and supplemental guide undoubtedly reflect our own implicit biases, with room for continued progress. This limitation speaks to what has previously been highlighted as a balance, in the process of rewriting milestones, between the perspective of educators who use them and that of content experts 25 . In the future, targeted inclusion of content experts into the working group may yield more robust milestones that reflect leading knowledge in domains such as diagnostic reasoning, evidence‐based practice, quality improvement, patient safety, and health equity, among others.…”

Section: Future Directions: Milestones 30 and Entrustable Professiona...mentioning

confidence: 93%

What to know about 2.0: Revisions to the pediatric emergency medicine milestones

Sagalowsky

Rudinsky

Gray

et al. 2023

AEM Education and Training

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Introduction The Accreditation Council for Graduate Medical Education (ACGME) adopted educational milestones for trainee assessment in 2013, as a key component of the Next Accreditation System. Two years later, the ACGME, American Board of Pediatrics (ABP), and American Board of Emergency Medicine (ABEM) collaborated to create specialty‐specific subcompetencies in pediatric emergency medicine (PEM). Since that time, emerging data have demonstrated the need to revise specialty milestones. Consequently, the ACGME summoned a working group to revise the original PEM milestones. Methods The PEM Milestones 2.0 Working Group convened in April 2021, comprising diverse representation from ACGME staff, PEM and EM attendings, PEM fellowship program directors, PEM fellows, and community members, overseen by the ACGME's vice president for milestones development. The group met virtually six times over 3 months, with concurrent independent and subgroup work, to draft the PEM Milestones 2.0 and supplemental guide. Results The working group's revisions generated concise descriptions of behavioral anchors to define skill acquisition more accurately; attention to the transition from residency to fellowship training; incorporation of harmonized milestones for non–patient care and non–medical knowledge domains; and increased emphasis on diversity, equity, and inclusion. A supplemental guide was also designed to aid programs in designing programmatic assessment related to specialty‐specific milestones. Conclusions The PEM Milestones 2.0 provide an updated, specialty‐specific framework to guide the development and assessment of PEM fellows and training programs. Future work may focus on faculty and learner development, advancing validity evidence, strengthening content expertise, and integrating milestones with specialty‐specific entrustable professional activities.

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“…10 A milestones revision work group was convened to develop the Psychiatry Milestones 2.0. 11 As part of that process, the Psychiatry Milestones 2.0 Work Group was given the opportunity to adjust the harmonized milestones to better suit the needs of psychiatry as a specialty. The group received feedback from individuals and organizations regarding the harmonized well-being subcompetency, including a letter from the American Association of Directors of Psychiatric Residency Training (AADPRT).…”

Section: Burnout and Depression Are Majormentioning

confidence: 99%

Challenges of Assessing Resident Competency in Well-Being: Development of the Psychiatry Milestones 2.0 Well-Being Subcompetency

et al. 2022

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Burnout and depression are major problems facing physicians, with 300–400 physicians dying by suicide each year. In an effort to address this issue, the Accreditation Council for Graduate Medical Education (ACGME) revised the Common Program Requirements for residency and fellowship programs to include a strong emphasis on well-being, and this revision has been extended to including a subcompetency on well-being in the Milestones 2.0. The Psychiatry Milestones 2.0 Work Group was convened to draft updated psychiatry milestones. As part of the open feedback period, the American Association of Directors of Psychiatric Residency Training submitted an organizational letter outlining several points to consider regarding the original draft of the well-being subcompetency. The ACGME was receptive to this feedback and allowed the Psychiatry Milestones 2.0 Work Group to revise the subcompetency. Current research indicates that burnout is largely driven by systemic factors, but well-being literature and initiatives often focus on individual factors and responsibility for burnout rather than systemic change. Program directors tasked with assessing resident well-being can additionally encounter several professionalism concerns, including how to (1) define a subcompetency within a competency that itself has not been well defined; (2) decide the appropriate balance between individual and systemic responsibility for well-being; (3) consider mental health as a parameter of well-being; (4) balance roles as physicians, psychiatrists, and training directors in thinking about the mental health of residents without overstepping boundaries and while maintaining privacy, confidentiality, and resident safety; and (5) measure well-being in a sociocultural context. This article describes how these considerations were incorporated into the revision of the Psychiatry Milestones 2.0 version of the well-being subcompetency, which has subsequently been made available to other specialty work groups for potential use as they develop their specialty-specific Milestones 2.0.

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The Psychiatry Milestones 2.0: How Did We Get from 1.0 to 2.0 and What Can Users Expect?

Cited by 12 publications

References 14 publications

Pediatric emergency medicine fellows’ milestone evaluations: Do they all meet the targets for graduation?

Pediatric emergency medicine fellows’ milestone evaluations: Do they all meet the targets for graduation?

What to know about 2.0: Revisions to the pediatric emergency medicine milestones

Challenges of Assessing Resident Competency in Well-Being: Development of the Psychiatry Milestones 2.0 Well-Being Subcompetency

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