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Milestones 2.0: A Step Forward.

A key component of the Next Accreditation System are the Educational Milestones for all accredited residency and fellowship programs. Use of the milestones in trainee assessment began in 2013, as a key element of the Accreditation Council for Graduate Medical Education’s (ACGME’s) Next Accreditation System. Milestones are used in resident and fellow outcomes-based assessment based on the 6 general competencies: medical knowledge (MK), patient care (PC), interpersonal and communication skills (ICS), practice-based learning and improvement (PBLI), professionalism (PROF), and systems-based practice (SBP). The 6 competencies were introduced by the ACGME and the American Board of Medical Specialties (ABMS) in 1999. While the competencies were crafted with the intent to provide a shared model of professional development and advance assessment of physicians in training, their implementation faced challenges, as programs, faculty, and trainees lacked an understanding of the meaning of the competencies in the context of their specialty. In response, content experts from each specialty created subcompetencies, using narrative milestones to provide more specific and developmental descriptions of the general competencies. This included representatives from the ACGME Residency Review Committees, ABMS certification boards, program director groups, specialty societies, and residents and fellows. These volunteers collectively gave more than 5000 hours of their time to develop the specialty-specific milestones. These milestones were intended ‘‘to create a logical trajectory of professional development in essential elements of competency’’ and provided a ‘‘measurable framework of specialty-specific outcomes.’’ When the milestones were first developed, each specialty had the flexibility to identify subcompetencies and write associated developmental milestones. Specialties reviewed program requirements, certification examination outlines and blueprints, curricula, national competency statements, the literature, and results from national consensus-building exercises to guide their process.