Understanding Evaluations and Progression
Have you ever wondered how residency programs evaluate your performance?
What does the ACGME require of residents for graduation?
Click here to read the full ACGME PDF that all residencies utilize.
Residents are evaluated on 22 specific MILESTONES, defined by the ACGME, which are broken into six categories.
The 22 Resident-specific Milestones, as defined by the ACGME:
1. Gathers and synthesizes essential and accurate information to define each patient’s clinical problem(s). (PC1)
2. Develops and achieves comprehensive management plan for each patient. (PC2)
3. Manages patients with progressive responsibility and independence. (PC3)
4. Skill in performing procedures. (PC4)
5. Requests and provides consultative care. (PC5)
6. Clinical knowledge (MK1)
7. Knowledge of diagnostic testing and procedures. (MK2)
8. Works effectively within an interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and other support personnel). (SBP1)
9. Recognizes system error and advocates for system improvement. (SPB2)
10. Identifies forces that impact the cost of health care, and advocates for, and practices cost-effective care. (SBP3)
11. Transitions patients effectively within and across health delivery systems. (SBP4)
12. Monitors practice with a goal for improvement. (PBLI1)
13. Learns and improves via performance audit. (PBLI2)
14. Learns and improves via feedback. (PBLI3)
15. Learns and improves at the point of care. (PBLI4)
16. Has professional and respectful interactions with patients, caregivers and members of the interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and support personnel). (PROF1)
17. Accepts responsibility and follows through on tasks. (PROF2)
18. Responds to each patient’s unique characteristics and needs. (PROF3)
19. Exhibits integrity and ethical behavior in professional conduct. (PROF4)
20. Communicates effectively with patients and caregivers. (ICS1)
21. Communicates effectively in interprofessional teams (e.g. peers, consultants, nursing, ancillary professionals and other support personnel). (ICS2)
22. Appropriate utilization and completion of health records. (ICS3)
•Patient Care (PC 1 – 5)
•Medical Knowledge (MK 1 – 2)
•System-Based Practice (SBP 1- 4)
•Practice-Based Learning & Improvement (PBLI 1- 4)
•Professionalism (Prof 1- 4)
•Interpersonal Communication (ICS 1 – 3)
Residents are scored on the individual milestones using a 5 point ENTRUSTMENT SCALE. Per the ACGME, residents must score a 3.5 or greater by the end of their residency in order to graduate.
Entrustment Scale Scoring
1 = Resident cannot consistently perform this skill, even with assistance.
2 = Resident can perform this skill but only under direct (i.e. physically present or immediately available) supervision by a more senior member of the team
3 = Resident can perform this skill with indirect supervision (i.e. immediately available by phone or senior member checking after completed).
4 = Can do this at the level of a general IM attending
5 = Expert, advanced skill beyond that of general IM attending.
Curriculum consists of the structured learning tools (ambulatory modules, didactics, clinical teaching, etc.) and specific objectives set forth by each individual rotation. These are listed on New Innovations under Schedules --> Curriculum.
Assessments are tools used by the program to evaluate a resident's progress toward each Milestone.
Intraining Exam scores
Continuity clinic evals
End-of-the-Month rotation evals
Targeted Direct Observation
Clinical Competency Committee (CCC) and the Milestone Report
The assessments are then used by the Clinical Competency Committee (CCC) to generate a semi-annual "Milestone Report," which is required by the ACGME. This report assigns a resident a numeric score in each of the 22 Milestones, utilizing the Entrustment Scale.
Clinical Competency Committee
•Associate Program Directors
Reviews All Resident Files at least twice per year.
All proceedings are confidential.
Mentorship comes in many forms in our program. Mentorship opportunities include:
Coach - assigned to each intern
CCC APD Advisor
Semi Annual Program Director meetings
Your report is available for you to review any time online through New Innovations.
--> My Reviews
CCC APD Advisor
Your Role, and what you can do to influence your Milestone Report
Get the most out of the curriculum provided
Set Goals! Get input from your evaluations, your observation of peers and role models, and your own personal aspirations. Be accountable to yourself regarding your progress toward these goals.
Meet with your coach or informal mentors, and discuss the change you want to see.