Steve Craig, MD & Danny Takanishi, MD and Members of the TY Milestones Working Group

 Background: ACGME Outcome Project: Milestone Development Phase  Use of Milestones in the ACGME’s Next Accreditation System  TY Milestones Development Process  Summary of TY Milestones Working Group Progress  Review of TY Medical Knowledge Milestone  Next Steps in TY Milestones Development  Questions for Panel

Susan Swing, PhD ~ ACGME Annual Educational Conference ~ March 2, 2012

 Late 2010: ACGME asked Steve Craig (CTYPD) + Danny Takanishi (TYRC) to co-chair Working Group  Early 2011 call for interested TYPDs to apply  Co-Chairs & ACGME staff selected core working group (other applicants to serve as advisory group)  Arranged first TY Milestones Working Group Meeting in Chicago May 3-4, 2011

 Co-Chairs: Steve Craig & Danny Takanishi  CTYPD Members: Matt Short, Cathy Nace, Marko Jachtorowycz  At-Large Members: Nikhil Goyal, Ernest Moritz, Ethan Natelson, Mukta Panda  Additional TYRC Member: Robert Bing-You  Resident Member : Karolyn Wanat  Staff Support: Steve Nestler, Linda Thorsen

 Overview of ACGME Milestones Project provided  Discussed Goals + Desired Work Product  Reviewed Organizational Framework  Reviewed Milestones Work from Other Specialties (especially IM, Pediatrics, General Surgery)  Began Milestone Development for Patient Care & Medical Knowledge competencies

Milestones Developmental Decisions Competence observed in performance → Articulate milestones in behavioral language Multiple evaluation approaches needed → Link milestones to general evaluation strategies “Competence” is tricky along the education continuum → Expectation at end of PGY-1 Year: safe to enter independent practice?

 We are the only one-year residency training program  We do not typically produce graduates ready for unsupervised practice  Need TY milestones to be equivalent to preliminary year training milestones (e.g. Medicine + Surgery)  Need TY milestones to be accepted by categorical specialty programs that our graduates enter  Need milestones to be achievable and measurable in shortened one year training period

 Three Meetings to Date  May 3-4, 2011 : Orientation, Organization, Review of other specialty’s milestones, Work on Patient Care (PC) + Medical Knowledge (MK) milestones  October 13-14, 2011 : Worked on milestones for other 4 competencies (reviewed Expert Panel’s work) + refined PC & MK Milestones  March 1, 2012 : Refined milestones for all 6 competencies: PC, MK, ICS, PBLI, Prof, SBP  March/April 2012 : Assessment instruments for milestones considered

 Milestones for all 6 competencies  Possible assessment tools that can be used for each milestone  Tomorrow morning’s workshop will review current draft of all the milestones + recommended assessment tools  Split into 5 groups: Share input with Working Group members who will lead each group

 Will briefly review Medical Knowledge milestone today  Discuss format used for milestones + how assessment tools identified  Tomorrow morning’s workshop: Split into 5 groups to review other milestones  Working Group Members will lead each of 5 groups  Seek input, comments, suggestions about individual milestones and recommended assessment tools

 Milestone Construct: Articulate in behavioral language  Key assessment points  Beginning of Training ( Novice )  After 6 Months of Training ( Advanced Beginner )  End of TY Training ( Competent )  End of Categorical Training ( Proficient )  Practicing Physician ( Expert )  Assessment Methods / Tools (See Handout)

 Synthesize feedback on milestones draft from this workshop + from recent TYRC review  Advisory Group to review milestones draft  Arrange for Categorical Residency Program Reps to review milestones draft  TY Milestones Working Group will meet to finalize milestones based on this input  Work with ACGME staff and TY RRC to finalize milestone reporting mechanism for TY programs

 Faculty development to increase understanding of the 6 competency domains  Introduce principles of CBME: culture shift to criterion-referenced assessment  Begin structuring competency committee(s)  Composition? How many?  Determine how to assess resident milestone performance  Determine how to compile/synthesize assessments  When milestones are available  Begin to align assessment tools  Discuss expected performance at different levels

& DISCUSSION

0700 : Bootcamp for New Program Directors 0800 : TY Milestones Workshop Bring your assessment tools handout! 0900 : TY Best Practices