Accreditation Council for Graduate Medical Education
Milestone Project Update
Emergency Medical Services
January 17, 2014
Jane Brice MD, MPH
Professor
Laura Edgar EdD, CAE
Executive Director
Presentation Topics
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Milestone Background and Purpose
Implementation
Clinical Competency Committees
Breakout Groups
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THANK YOU
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Peter Pons, MD
Debra Perina, MD
Mike Beeson, MD
Stacy Weisberg, MD
Noel Wagner, MD, NREMT-P
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Jane Brice, MD, MPH
Charles Beaudette, MD (Fellow)
Nicholas Rathert, MD (Fellow)
Felicia Davis
Anne Harvey, PhD
Milestones: What
• Milestones describe performance levels fellows are
expected to demonstrate for skills, knowledge, and
behaviors in the six competency domains.
• Milestones will lay out a framework of observable
behaviors and other attributes associated with
fellows’ development as physicians.
• In the next accreditation system , aggregate fellow
performance on the milestone level will be used as
one indicator of a fellow’s educational
effectiveness.
Nasca, TJ et. Al. The Next Accreditation System. 2012.366:1051-1056
Key Points: Milestones
 Articulate shared understanding of
expectations
 Describe trajectory from beginner in the
specialty to exceptional resident or
practitioner
 Organized under six domains of clinical
competency
 Represent a subset of all sub-competencies
 Set aspirational goals of excellence
Milestones: Why
• Fulfill the promise of the Outcome Project:
Increased use of educational outcome data in accreditation
• ACGME accountability to public
• Support the educational process
Uses and Implications
ACGME
Fellowship Programs
• Accreditation – continuous monitoring of
programs; lengthening of site visit cycles
• Public Accountability – report at a national level
on competency outcomes
• Community of practice for evaluation and
research, with focus on continuous
improvement
• Guide curriculum development
• More explicit expectations of fellows
• Support better assessment
• Enhanced opportunities for early
identification of under-performers
Milestones
Certification Boards
Fellows
• Potential use – ascertain whether
individuals have demonstrated
qualifications needed to sit for Board exams
• Increased transparency of performance
requirements
• Encourage fellow self-assessment and selfdirected learning
• Better feedback to fellows
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Milestone Template
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EMS Milestones Group
Came together for a 1.5 day meeting
We had representatives from the RRC, ABEM, NAEMSP
and two recently graduated fellows
Made decisions about framework for milestones and then
got to work
EMS Milestones
Options for creation and organization of milestones – many
to choose from:
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EMS Core Content
EMS Curriculum
EMS Board Exam Outline
EMS Program Requirements
Fellowship Experience (both as a fellow and as a program
director
EMS Milestones
• Organized under the 6 domains of Clinical Competence
• Patient care
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4.
5.
Procedures performed in the prehospital environment
Prehospital recognition and stabilization of time/life-critical conditions
Recognition and treatment of prehospital conditions
Mass casualty and disaster management
General special operations in EMS
EMS Milestones
• Medical knowledge
6. Medical oversight
• Systems-based practice
7. EMS personnel (supervision and training)
8. System management
• Practice-based Learning and Improvement
9. Quality management
10. Research
EMS Milestones
• Professionalism
11. Ethics and professional behavior
12. Accountability
• Interpersonal Communication Skills
13. Team communications and management
14. Patient-centered communications
Milestones are progressive over
time. There is no prescribed speed at
which residents must complete a
milestone set.
Selecting a response box in the middle
of a level implies that milestones in
that level and in lower levels have
been substantially demonstrated.
Selecting a response box on the line in between
levels indicates that milestones in lower levels have
been substantially demonstrated as well as some
milestones in the higher level(s).
When should we start?
NOW
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Accreditation Council for Graduate Medical Education
What is the
Clinical Competency
Committee?
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Clinical Competency Committee
 Composed of a minimum of 3 faculty members
 Non-physician members can be appointed
 Reviews all evaluations by all evaluators semiannually
 Reviews residents against milestones semiannually
 Make recommendations for progress –
promotion, remediation and dismissal
 http://www.acgme-nas.org/assets/pdf/CPRs2013.pdf
Accreditation Council for Graduate Medical Education
How does the CCC
actually work?
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Who should be on the CCC?
• Decision for PD
• Consider:
• Representation from each major site
• Subspecialty representation
• Dedication to education
How do we DO the
evaluation?
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Understand the milestones & their use
Leave personal bias at the door
Review all evaluations for each resident
“Consider the source(s)”
For each resident, decide for each
milestone the narrative that best fits
that resident
The Clinical Competency Committee
Avoids common problematic issues:
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“I don’t like to give negative evaluations”
“I spent little time working with this resident”
“Herd” mentality: positive or negative
Grade inflation
Vague statements:
• “I just didn’t like this resident, but I can’t put my finger
on it”
• Hearsay: I’ve heard she is lazy
Clinical Competence
Committee
Operative
Performance
Rating
Scales
Nursing and
Ancillary
Personnel
Evaluations
OSCE
Peer
Evaluations
© 2012 Accreditation Council for
Graduate Medical Education (ACGME)
Mock
Orals
Self
Evaluations
End of
Rotation
Evaluations
ITE
Case
Logs
Unsolicited
Comments
Sim
Lab
Clinical
Competence
Committee
Assessment of
Milestones
Student
Evaluations
Clinic Work
Place
Evaluations
Patient /
Family
Evaluations
Milestones: Reporting
• All programs within a specialty use the specialty’s
milestones
• Programs will report semi-annually
• Milestone data will be reported to ACGME through direct
entry into ADS
Implementation
• Next Accreditation System for EMS starts July 1, 2014
• First Milestone reporting is December 2014
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MOCK CCC
• Break into groups – members of the Milestone Group are
here and can help answer questions
• Evaluate Resident X against a 6 milestones
• Share your experience with your faculty – excellent
faculty training opportunity
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Accreditation Council for Graduate Medical Education
Thank you!
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Contact Information
Accreditation Questions:
Felicia Davis fdavis@acgme.org
Milestones Questions:
Laura Edgar ledgar@acgme.org
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