Using ACGME General Surgery Milestones to Define the Competent Foundational Surgical Resident

• Published in: Journal of surgical education Vol. 81; no. 7; pp. 973 - 982
• Main Authors: Doster, Dominique, Hunt, Maya L., Thomas, Christopher M., Krusing, Madeline B., Miller, Payton M., Choi, Jennifer, Stefanidis, Dimitrios, Matthew Ritter, E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Accreditation; ACGME; Clinical Competence; Competency; Competency-Based Education; Education, Medical, Graduate; Educational Measurement; Female; General Surgery - education; Humans; Internship and Residency; Male; Milestones; Standard setting; United States; United States; Milestones; Standard setting; Practice based learning and improvement; ACGME; Competency
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2024.03.016

•Milestones can be used as a conceptual framework to define competency standards.•Milestone standards can provide a foundation to build a program of assessment.•Competency standards reflect culture and expectations of individual institution.•This methodology can be readily replicated at other programs. In transitioning to competency-based surgical training, the need to clearly define competency is paramount. The purpose of this study is to define the well-prepared foundational resident using the ACGME General Surgery Milestones as our conceptual framework. Participants reflected on their expectations of a well-prepared resident at the end of PGY1, then assigned milestone levels reflecting this level of competence for General Surgery Milestones 1.0 and 2.0. Subcompetency scores were averaged among residents and faculty. The level of the well-prepared foundational resident was determined based on the highest level within one standard deviation of faculty, resident, and total group averages. This took place during a dedicated education retreat at a single, large academic general surgery residency program. Key faculty stakeholders and a representative sample of residents (PGY 1-5) within our institution participated. Eight faculty and five residents completed Milestones 1.0 and 2.0 scoring. Mean scores between faculty and residents were compared. For 1.0, mean scores for Practice-Based Learning and Improvement 3 (PBLI 3) and Interpersonal Communication Skills 3 (ICS 3) were discernably lower for residents than for faculty (PBLI 3 1.3 (0.3) v 0.9 (0.2), p = 0.01; ICS3 1.6 (0.6) v 1.1 (1), p = 0.01). Scores of 2.0 were comparable across all subcompetency domains. With this broad agreement, Milestone-based competency standards were determined. Descriptive narratives of the KSAs were created for each subcompetency, combining the determined Milestones 1.0 and 2.0 levels. We were able to clearly define the competent foundational resident using the ACGME Milestones as a conceptual framework. These Milestone levels reflect the culture and expectations in our department, providing a foundation upon which to build a program of assessment. This methodology can be readily replicated in other programs to reflect specific expectations of the program within the larger ACGME frameworks of competency.