Longitudinal Milestone Assessment Extending Through Subspecialty Training

The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones

Bibliographic Data

ID21615258
AuthorsJanae K Heath (0000-0002-0533-3088, J.K. Heathis assistant professor, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID:., corresponding author), Tisha Wang (0000-0002-4452-2148, University of California System), Lekshmi Santhosh (0000-0002-9897-3462, University of California System), Joshua L Denson (0000-0002-8654-7765, J.L. Densonis assistant professor, Section of Pulmonary, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana; ORCID:.), Eric S Holmboe (0000-0003-0108-6021, Accreditation Council for Graduate Medical Education), Eric Holmboe (Yale University), Kenji Yamazaki (0000-0002-7039-4717, K. Yamazakiis senior analyst, Accreditation Council for Graduate Medical Education, Chicago, Illinois.), Alison S Clay (0000-0003-3191-5345, Duke University), W Graham Carlos (0000-0002-5343-2312, Indiana University)
Year2021
Volume96
Issue11
Pages1603-1608
Publication date2021-11-01
Open AccessNo
TypeARTICLE
VenueAcademic Medicine (JOURNAL)
Journal identifiersISSN: 1040-2446 • E-ISSN: 1938-808X
PublisherOxford University Press (OUP) (PUBLISHER)
DOI10.1097/acm.0000000000004165
PMID34010863
OpenAlexW3162043344
LanguageEN
Citations received2
References cited28

PURPOSE: Accreditation Council for Graduate Medical Education (ACGME) milestones were implemented across medical subspecialties in 2015. Although milestones were proposed as a longitudinal assessment tool potentially providing opportunities for early implementation of individualized fellowship learning plans, the association of subspecialty fellowship ratings with prior residency ratings remains unclear. This study aimed to assess the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones. METHOD: A multicenter retrospective cohort analysis was conducted for all PCCM trainees in ACGME-accredited PCCM fellowship programs, 2017-2018, who had complete prior IM milestone ratings from 2014 to 2017. Only professionalism and interpersonal and communication skills (ICS) were included based on shared anchors between IM and PCCM milestones. Using a generalized estimating equations model, the association of PCCM milestones ≤ 2.5 during the first fellowship year with corresponding IM subcompetencies was assessed at each time point, nested by program. Statistical significance was determined using logistic regression. RESULTS: The study included 354 unique PCCM fellows. For ICS and professionalism subcompetencies, fellows with higher IM ratings were less likely to obtain PCCM ratings ≤ 2.5 during the first fellowship year. Each ICS subcompetency was significantly associated with future lapses in fellowship (ICS01: β = -0.67, P = .003; ICS02: β = -0.70, P = .001; ICS03: β = -0.60, P = .004) at various residency time points. Similar associations were noted for PROF03 (β = -0.57, P = .007). CONCLUSIONS: Findings demonstrated an association between IM milestone ratings and low milestone ratings during PCCM fellowship. IM trainees with low ratings in several professionalism and ICS subcompetencies were more likely to be rated ≤ 2.5 during the first PCCM fellowship year. This highlights a potential use of longitudinal milestones to target educational gaps at the beginning of PCCM fellowship

Accreditation · Family medicine · Graduate medical education · Medical education · MEDLINE · Milestone · Subspecialty · Diversity and Career in Medicine · Hospital Admissions and Outcomes · Innovations in Medical Education · Medicine

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