Implementing Milestones: Historical context, competency based medical education, and outcomes CORD Academic Assembly April 2, 2012 Felix Ankel Michael Beeson Patrick Brunett

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Worldle map

Dreyfus model of skill acquisition

Six Aptitudes

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Milestones n Observable, measurable behaviors n Acknowledges developmental stages n Linked to level of training n Expected time frame for achievement

Milestones n Narrative anchors n Based on knowledge, skills and attitudes –KSAs n Balance between –Deconstruction (microtasks) –Integration (complex performance)

Milestones n 5 levels of proficiency –Novice (entry level med school graduate) –Beginner –Competent –Proficient (graduating resident) –Expert (advanced practitioner)

Assessment under New Accreditation System n Continuous process n OK for trainees to meet expectations ahead of schedule n Failure to meet milestones may trigger further assessment, intervention, remediation

n Integrated set of complex performance expectations n Personal and professional development n Done with (not to) residents n Reported every 6 months n Assessment of program effectiveness Assessment under New Accreditation System

n Integrated set of complex performance expectations n Personal and professional development n Done with (not to) residents n Assessment of program effectiveness Assessment under New Accreditation System

Example from Internal Medicine

EM Milestones n Aligned with core competencies n Specialty-specific vs. universal skills n Parallels development of ABEM Initial Certification criteria n Linked to “Physician Tasks” (Model of Clinical Practice of EM)

EM Milestones under New Accreditation System n Roll out of pilot in 2013 n One of 7 “early adopter” specialties –emergency medicine –internal medicine –neurosurgery –orthopedics –pediatrics –radiology –urology