The Psychiatry Milestones: New Developments and Challenges

Does One Size Truly Fit All? The COUPE Undergraduate Perspective on Competency-Based Medical Education in Psychiatry

“…22(p2) This has led to the development of "milestones," facilitating the developmental progression of observable behaviours, [23][24][25] although the Milestones Project has been perceived by some as idealistic and limited in its implementation considerations. 13 The CBME model should include explicit expectations and assessments while avoiding deconstruction into increasingly smaller competency units or focus on competencies that are easy to describe and assess. 19 Ideally, these simpler competencies would establish a solid foundation for CBME at the UGME level.…”

“…This developmental progression and shift in focus will require that faculty and residents think differently about assessment, accepting that performance at a "lower" level on the milestone reporting form is acceptable and expected for an early learner. This will represent a cultural shift for learners and assessors, focussing on development, not outcome, through constant improvement and remediation, 12,13 concepts central to lifelong learning.…”

“…6 However, increasing discussion has raised numerous questions and concerns about CBME. 1,5,[7][8][9][10][11][12][13][14][15] The most commonly cited concerns have revolved around the intrinsically reductionist nature of the CBME model, the amount and frequency of assessment and resources required, the faculty development necessary to ensure competency of the evaluators, and the risk of overemphasizing the skills and knowledge aspects of medical education over the professionalism and integration abilities of a good physician.…”

The Competency Movement in Psychiatric Education

“…The competency movement revolutionized graduate medical education [2]. In psychiatry, the Psychiatry Milestones, part of the Next Accreditation System (NAS) of the ACGME implemented and institutionalized the competency movement [3].…”

“…Beresin et al [2] recently noted, however, that the NAS and Psychiatry Milestones are "largely idealistic" and have insufficiently addressed the practical issues of assessment, documentation, and graduate medical education funding required to develop outcome measures, train faculty to use assessment tools, and develop means of reporting outcomes to the ACGME and other regulatory agencies. Articulating a similar concern, Dewan et al [6] pointed out that the Milestones include 6 competency domains, 22 subcompetency domains, 65 threads, and 324 milestones distributed across 5 levels.…”