4.  Essential component of NAS are the MILESTONES  Basis is to track development in the 6 competencies  Dreyfus Model: -Novice -Advanced beginner -Competent -Proficient -Expert -Master Milestones

5.  RRC  Boards  P.D.’s  Residents Milestones Milestones Developed By

6. Develop by December 2012 Submission to ACGME 2013 & 2014 Milestones Will Supplement, Not Replace Existing Assessment Tools Timeline: Milestones

7. Could you present your experience with the Milestones?

8. The Orthopaedic Surgery Milestones I. Martin Levy, MD Program Director Professor of Clinical Orthopaedic Surgery

9. The Milestones are Coming Here

10. The only thing we have to fear is FEAR ITSELF … and spiders …and maybe the milestones

11. So we gathered our Chiefs of Service.

12. Like everyone else, we took our toolbox and started to figure out ways to recognize a competent resident.

14. We developed goals and objectives for each service.

15. This was not the easy part. But we ended up with a handbook.

16. While doing our G&O’s, we started playing with technical milestones. We called them Index Procedures. We began using these Index Procedures as a way to assess achievement of independence.

18. I brought these IP’s to CORD’s Technical Competency Committee. During these discussions I became aware of the ACGME Milestone Project.

19. “A good plan violently executed now, is better than a perfect plan executed next week.” George S. Patton Jr.

20. While not ecstatic over the knowledge that index procedures were going to morph into the more complex milestones, COS familiarity with IP’s and G&O’s made the transition less painful…for me.

21. Dr. Nasca wrote his article, NAS became a household word and the the Milestone Project arrived at our doorstep.

22. We were fortunate that the Orthopaedic Knowledge Base and Patient Care milestones were prescriptive and organized by subspecialty.

26. Each Chief of Service was asked to review their service specific milestones and discuss feasibility.

27. They have successfully created a curriculum that supports the knowledge base and develops the required surgical techniques and clinical skills.

28. Gets a real time review For applicable Milestones only And these are uploaded Each resident on a service

29. Clinical Competency Committee (C.C.C.)  Core faculty  Program director-  Chief resident Include Function Function  Evaluate milestones & early warning  Track progress of residents  Faculty development  Reduce potential bias  Performance measure  Decision making by multiple people  Evaluate 360° assessments Purpose

30. So we identified our Clinical Competency Committee.

33. The C.C.C. was thrilled.

34. From the C.C.C. each resident receives: Summative evaluation Twice a year And these are uploaded

35. At this early stage, and with what is at stake, I believe the only way to insure reliable input, is by meeting regularly with my Chiefs of Service.

36. Thank you