Preparing for the First Milestone: Room for Improvement?

Abstract

BACKGROUND: Specialty specific clinical milestone assessment begins with milestone level one, expected of incoming interns. In 2014, the ACGME required medical schools offer post match in-specialty training with the goal of attaining milestone level one. METHODS: An online survey was sent to Ob/Gyn interns nationwide in early 2015 assessing participation in required training and perceived entry-level skill sets. A free response section solicited suggestions for improvement of the milestones program. Of 1,276 interns, 145 (11.4%) responses were received. The χ2 test was used to compare responses between groups. RESULTS: Of respondents, 19.31% stated they participated in specialty specific milestones training. Among those taking the course, a statistically significant increase in interns feeling “very prepared” for Labor and Delivery duties was noted (23.08% versus 5.61%) (P=.036). No significant differences were perceived in overall preparedness, gynecologic surgery, or office based Ob/Gyn. DISCUSSION: This study highlights a lack of both universal implementation and a standardized curriculum, as well as a misunderstanding of program goals and milestone evaluation criteria. Many respondents suggest better training for triage, obstetrical emergencies, office gynecology, and minor gynecologic procedures. Improved participation and creation of realistic participant expectations at the outset, a greater focus on role playing simulations, and implementation of feedback may improve the effectiveness of the course.