The Internal Medicine Reporting Milestones and the Next Accreditation System
Authors: Kelly J. Caverzagie, William F. Iobst, Eva M. Aagaard, Sarah Hood, Davoren A. Chick, Gregory C. Kane, Timothy P. Brigham, Susan R. Swing, Lauren B. Meade, Hasan Bazari, Roger W. Bush, Lynne M. Kirk, Michael L. Green, Kevin T. Hinchey, Cynthia D. Smith
Journal: Annals of Internal Medicine (2013)

Ideas and Opinions2 April 2013The Internal Medicine Reporting Milestones and the Next Accreditation SystemKelly J. Caverzagie, MD, William F. Iobst, MD, Eva M. Aagaard, MD, Sarah Hood, MS, Davoren A. Chick, MD, Gregory C. Kane, MD, Timothy P. Brigham, PhD, Susan R. Swing, PhD, Lauren B. Meade, MD, Hasan Bazari, MD, Roger W. Bush, MD, Lynne M. Kirk, MD, Michael L. Green, MD, Kevin T. Hinchey, MD, and Cynthia D. Smith, MDKelly J. Caverzagie, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., William F. Iobst, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Eva M. Aagaard, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Sarah Hood, MSFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Davoren A. Chick, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Gregory C. Kane, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Timothy P. Brigham, PhDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Susan R. Swing, PhDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Lauren B. Meade, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Hasan Bazari, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Roger W. Bush, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Lynne M. Kirk, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Michael L. Green, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., Kevin T. Hinchey, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut., and Cynthia D. Smith, MDFrom University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-7-201304020-00593 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcomes Project in 1999, which requires resident training programs to assess trainee accomplishment of learning objectives across 6 general domains of competence: patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills (1). To facilitate this initiative, the ACGME launched the Milestones Project in 2009, charging each specialty to identify "the milestones of competency development" (2). Milestones are observable developmental steps that describe progression from a beginning learner to the expected level of proficiency at the completion of training. Accordingly, predefined milestones can be ...References1. Swing SR. The ACGME outcome project: retrospective and prospective. Med Teach. 2007;29:648-54. [PMID: 18236251] CrossrefMedlineGoogle Scholar2. Nasca TJ. The next step in the outcomes-based accreditation project. ACGME Bulletin. 2008;:2-4. Google Scholar3. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. N Engl J Med. 2012;366:1051-6. [PMID: 22356262] CrossrefMedlineGoogle Scholar4. Green ML, Aagaard EM, Caverzagie KJ, Chick DA, Holmboe E, Kane G, et al. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ. 2009;1:5-20. [PMID: 21975701] CrossrefMedlineGoogle Scholar5. Regehr G, Regehr C, Bogo M, Power R. Can we build a better mousetrap? Improving the measures of practice performance in the field practicum. J Soc Work Educ. 2007;43:327-43. CrossrefGoogle Scholar6. Accreditation Council for Graduate Medical Education. Common program requirements. Effective 1 July 2011. Accessed at https://acgme.org/acgmeweb/Portals/0/dh_dutyhoursCommonPR07012007.pdf on 15 December 2012. Google Scholar7. Accreditation Council for Graduate Medical Education. Categorization of common program requirements. Accessed at www.acgme-nas.org/ccpr.html on 15 December 2012. Google Scholar8. Alliance for Academic Internal Medicine. Building assessments for an EPA in three steps. Accessed at http://im.org/AcademicAffairs/milestones/Pages/BuildingAssessmentsforanEPAinThreeSteps.aspx on 15 December 2012. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Nebraska Medical Center, Omaha, Nebraska; American Board of Internal Medicine, Jefferson Medical College, and American College of Physicians, Philadelphia, Pennsylvania; University of Colorado School of Medicine, Aurora, Colorado; University of Michigan Medical School, Ann Arbor, Michigan; Accreditation Council for Graduate Medical Education, Chicago, Illinois; Baystate Medical Center, Springfield, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts;Virginia Mason Medical Center, Seattle, Washington; University of Texas Southwestern Medical Center, Dallas, Texas; and Yale University School of Medicine, New Haven, Connecticut.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3103.Corresponding Author: Kelly J. Caverzagie, MD, University of Nebraska Medical Center, Department of Internal Medicine, 985185 Nebraska Medical Center, Omaha, NE 68198-5185; e-mail, kelly.[email protected]edu.Current Author Addresses: Dr. Caverzagie: University of Nebraska Medical Center, Department of Internal Medicine, 985185 Nebraska Medical Center, Omaha, NE 68198-5185.Dr. Iobst and Ms. Hood: American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.Dr. Aagaard: Mail Stop F495, Room 4102A, 13070 East 19th Avenue, Aurora, CO 80045.Dr. Chick: 3213 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI 48109.Dr. Kane: Jefferson Medical College, Division of Critical Care, 1025 Walnut Street, Philadelphia, PA 19107.Drs. Brigham and Swing: Accreditation Council for Graduate Medical Education, 515 North State Street, Suite 2000, Chicago, IL 60654.Drs. Meade and Hinchey: Department of General Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.Dr. Bazari: Massachusetts General Hospital, Fruit Street, Boston, MA 02114.Dr. Bush: Virginia Mason Medical Center 18-25, PO Box 900, 925 Seneca Street, Seattle, WA 98101.Dr. Kirk: University of Texas Southwestern Medical Center, General Internal Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390-8889.Dr. Green: Primary Care Residency Program, Waterbury Hospital, 64 Robbins Street, Waterbury, CT 06708.Dr. Smith: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.Author Contributions: Conception and design: K.J. Caverzagie, E.A. Aagaard, S. Hood, D.A. Chick, G.C. Kane, T.P. Brigham, S.R. Swing, L.B. Meade, H. Bazari, L.M. Kirk, M. Green, C.D. Smith.Analysis and interpretation of the data: S. Hood, D.A. Chick, T.P. Brigham, L.B. Meade, M. Green.Drafting of the article: K.J. Caverzagie, E.A. Aagaard, D.A. Chick, M. Green, C.D. Smith.Critical revision of the article for important intellectual content: K.J. Caverzagie, E.A. Aagaard, S. Hood, D.A. Chick, G.C. Kane, T.P. Brigham, L.B. Meade, H. Bazari, L.M. Kirk, M. Green, K.T. Hinchey, C.D. Smith.Final approval of the article: K.J. Caverzagie, E.A. Aagaard, D.A. Chick, G.C. Kane, T.P. Brigham, S.R. Swing, L.B. Meade, H. Bazari, L.M. Kirk, M. Green, K.T. Hinchey, C.D. Smith.Provision of study materials or patients: S.R. Swing.Administrative, technical, or logistic support: K.J. Caverzagie, S. Hood, G.C. Kane, S.R. Swing, C.D. Smith.Collection and assembly of data: S. Hood, S.R. Swing, L.M. Kirk, K.T. Hinchey.This article was published at www.annals.org on 29 January 2013. 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