ACGME Milestone Development in General Psychiatry: Patient Care and Medical Knowledge

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS) has mandated that all medical specialties develop educational Milestones that document observable steps in residents’ professional development from entry into the program to graduation and beyond [1]. TheMilestones were organized in a 5-level model beginning with Milestones when starting into the specialty, progressing to a graduation target, and endingwithMilestones that were “aspirational” goals. The developmental framework was derived from the Dreyfus model of expertise [2], though the 5-level model in the Milestones represents the progression from beginning resident to independent specialist rather than novice to expert as in the Dreyfus model. The Milestone Project is an explicitly stated set of expectations that links the ideals of the general competencies in each specialty to the realities of measurement. The development of agreed upon Milestones should generate coherent assessment tools that are more valid than those that exist for the six core general competencies [3]. Several specialties have now published Milestones and began implementation July 2013 [4]. The Psychiatry Milestones have recently been completed in a process that was similar to the initial specialties of Internal Medicine, Pediatrics, and Surgery. This process included formation of aWorking Group to develop the specificMilestones for each of the six competency areas. There were also several important differences from the work of the initial three Milestone groups in the structure of the process and the expectation to limit the number of sub-competencies to no more than 35. Feedback from various stakeholders was elicited throughout the process that included ongoing review with an Advisory Group, a formal pilot process with a limited number of training programs, a survey of training directors, and medical student educators and other groups submitting comments. This article will review the specific development of the patient care (PC) and medical knowledge (MK) subcompetencies and the corresponding Milestones.