Transcript Regions Emergency Medicine Residency

Implementing Milestones:
Historical context, competency based medical
education, and outcomes
CORD Academic Assembly
April 2, 2012
Felix Ankel
Michael Beeson
Patrick Brunett
http://www.youtube.com/watch?v=Q
y1dpLmJTrY&feature=related
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Worldle map
Dreyfus model of skill acquisition
Six Aptitudes
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Milestones
Observable, measurable behaviors
 Acknowledges developmental stages
 Linked to level of training
 Expected time frame for achievement
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Milestones
Narrative anchors
 Based on knowledge, skills and
attitudes
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– KSAs
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Balance between
– Deconstruction (microtasks)
– Integration (complex performance)
Milestones
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5 levels of proficiency
– Novice (entry level med school graduate)
– Beginner
– Competent
– Proficient (graduating resident)
– Expert (advanced practitioner)
Assessment under
New Accreditation System
Continuous process
 OK for trainees to meet expectations
ahead of schedule
 Failure to meet milestones may trigger
further assessment, intervention,
remediation
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Assessment under
New Accreditation System
Integrated set of complex performance
expectations
 Personal and professional development
 Done with (not to) residents
 Reported every 6 months
 Assessment of program effectiveness
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Assessment under
New Accreditation System
Integrated set of complex performance
expectations
 Personal and professional development
 Done with (not to) residents
 Assessment of program effectiveness

Example from Internal Medicine
EM Milestones
Aligned with core competencies
 Specialty-specific vs. universal skills
 Parallels development of ABEM Initial
Certification criteria
 Linked to “Physician Tasks” (Model of
Clinical Practice of EM)

EM Milestones under
New Accreditation System
Roll out of pilot in 2013
 One of 7 “early adopter” specialties
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emergency medicine
internal medicine
neurosurgery
orthopedics
pediatrics
radiology
urology