80 Implementation of Emergency Medicine Milestones: A National Survey

Abstract

The Emergency Medicine Milestone Project was created in 2012 by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine as a standardized assessment of the development of emergency medicine (EM) residents. Although programs are required to evaluate their residents utilizing the EM Milestones semi-annually it is unknown how programs educate interns and core faculty about the EM Milestones Project and their role in competency based-assessment. Our objective is to conduct a national survey to determine how EM programs educate interns and core faculty about the EM Milestones Project and to determine how the milestones are used in competency based-assessments. Our survey tool, which was designed as part of the Medical Education Research Certificate Program and deemed exempt by the Institutional Review Board at Alameda Health System (Highland Hospital), was comprised of 12 questions, 11 of which are multiple choice and 1 which is free response. The survey was distributed in 2017 over a 6-month period from July 2017 to January 2018 via the Council of Emergency Medicine Residency Directors listserv. Responses, which were de-identified with respect to program, were solicited from program directors, assistant/associate program directors, and core faculty. A single response from a program was considered sufficient. Of 201 EM programs nationwide, 140 responses were received (response rate 69.65%). 70.7% of responses were from program directors and 26.4% were from assistant/associate program directors. The most common modality for educating interns and core faculty about the EM Milestones was via the distribution of physical or electronic media (74.3% and 62.9%, respectively), with 57.9% of the programs educating interns within their first month of residency. 92.1% of programs utilize EM Milestones in semi-annual reviews and 74.3% of programs utilize EM Milestones in shift evaluations. Although 82.6% of respondents indicated that it was important for interns and core faculty to understand how EM Milestones are used in competency-based evaluations, only 50.7% felt that the EM milestones were a valuable tool. Furthermore, respondents estimated that 78.4% of interns and 48.6% of core faculty have a “fair to poor” understanding of how the the EM Milestones are utilized. These data suggest there is wide variability in how EM programs educate interns and core faculty about the EM Milestones, and there is disagreement as to whether the EM Milestones are a valuable tool in evaluating residents. Furthermore, there is sub-optimal understanding among interns and core faculty regarding how EM milestones are utilized in competency-based evaluations, which may stem from insufficient or inadequate knowledge dissemination.