Milestone Level Changes From Residency to Fellowship: A Multicenter Cohort Study

ABSTRACT Background A vital element of the Next Accreditation System is measuring and reporting educational Milestones. Little is known about changes in Milestones levels during the transition from residency to fellowship training. Objective Evaluate the Accreditation Council for Graduate Medical Education (ACGME) Milestones' ability to provide a linear trajectory of professional development from general pediatrics residency to neonatal-perinatal medicine (NPM) fellowship training. Methods We identified 11 subcompetencies that were the same for general pediatrics residency and NPM fellowship. We then extracted the last residency Milestone level and the first fellowship Milestone level for each subcompetency from the ACGME's Accreditation Data System on 89 subjects who started fellowship training between 2014 and 2018 at 6 NPM fellowship programs. Mixed-effects models were used to examine the intra-individual changes in Milestone scores between residency and fellowship after adjusting for the effects of the individual programs. Results A total of 1905 subcompetency Milestone levels were analyzed. The average first fellowship Milestone levels were significantly lower than the last residency Milestone levels (residency, mean 3.99 [SD = 0.48] vs fellowship 2.51 [SD = 0.56]; P < .001). Milestone levels decreased by an average of -1.49 (SD = 0.65) from the last residency to the first fellowship evaluation. Significant differences in Milestone levels were seen in both context-dependent subcompetencies (patient care and medical knowledge) and context-independent subcompetencies (professionalism). Conclusions Contrary to providing a linear trajectory of professional development, we found that Milestone levels were reset when trainees transitioned from general pediatrics residency to NPM fellowship.

Reasons for Data-Prompted Site Visits: Field Staff Findings and Review Committee Decisions

ABSTRACT Background A major component of the ACGME's Next Accreditation System (NAS) is the annual review of key performance indicators by each review committee (RC) for all programs under its oversight. The RC may request a site visit that is data-prompted for either a full review of all common and specialty-specific program requirements or a focused review of specific concerns for programs identified as underperforming. Objective The aims of this study were to: (1) identify the reasons that RCs requested data-prompted site visits; (2) describe the findings by accreditation field representatives as reflected in their site visit reports; and (3) summarize the accreditation decisions of RCs that followed the data-prompted site visits (DPSVs). Methods RC letters to programs informing them of a DPSV, site visit reports, and RC letters with accreditation decisions were reviewed for all programs having DPSVs from 2015 to 2020. Results DPSVs were performed in 312 programs, including 59 hospital-based, 122 medical-based, and 131 surgery-based programs; 214 programs had a single DPSV, and 98 programs had repeat DPSV. The most frequent reason that RCs requested a DPSV was noncompliance on the annual ACGME Resident/Fellow Survey. Notification of a DPSV prompted a change in program director in 7% of programs in the single DPSVs group and 57% of programs in the repeat DPSVs group. Surgery-based programs in the single and repeat DPSVs groups were more likely to receive an unfavorable accreditation status. The majority of programs in the single DPSVs group (78%) and repeat DPSVs group (70%) had a status of continued accreditation as of March 2020. Conclusions Noncompliance on the Resident/Fellow survey was the most frequent reason that RCs requested a DPSV. The majority of programs in the single and repeat DPSV groups achieved a favorable accreditation status.

Rising to the Challenge: Residency Programs' Experience With Implementing Milestones-Based Assessment

ABSTRACT Background Changes to assessment efforts following the shift to milestones-based assessment in the ACGME Next Accreditation System have not been fully characterized. Objective This study describes themes in initial milestones-based assessment practices with the goal of informing continued implementation and optimization of milestones-based assessment. Methods Semistructured interviews were conducted with 15 residency program leaders in 6 specialties at 8 academic medical centers between August and December 2016. We explored what was retained, what was added, and what was changed from pre-milestones assessment efforts. We also examined the perceived impact of the shift to milestones-based assessment on the programs. Thematic analysis began after the first 5 interviews and ended once thematic sufficiency was reached. Two additional authors reviewed the codes, offered critical input, and informed the formation and naming of the final themes. Results Three themes were identified: (1) program leaders faced challenges to effective implementation; (2) program leaders focused on adaptability and making milestones work in what felt like a less than ideal situation for them; and (3) despite challenges, program leaders see value and utility in their efforts to move to milestones-based assessment. We describe a number of strategies that worked for programs during the transition, with perceived benefits acknowledged. Conclusions While adaptation to milestones has occurred and benefits are noted, negative impacts and challenges (eg, perceived lack of implementation guidance and faculty development resources) persist. There are important lessons learned (eg, utilizing implementation experiences formatively to improve curricula and assessment) in the transition to milestones-based assessment.

Learning Styles in Pathology: A Comparative Analysis and Implications for Learner-Centered Education

Initiatives like “American Medical Association (AMA)-Reimagining Residency” and “Accreditation Council for Graduate Medical Education (ACGME)-Next Accreditation System” are examples of a paradigm shift toward learner-centered pedagogy in resident education. Such interventions require an understanding of the basics of the learning process itself. This study aimed to identify preferred learning styles in pathology with the intent to use specialty-specific pattern data, if any, to improve pathology training modalities. Kolb’s learning tool questionnaire was sent to pathology-inclined medical students, pathology residents, fellows, and faculty in 5 academic programs. Data from 84 respondents (6 students, 37 residents, 12 fellows, 29 attendings) were analyzed. There was remarkable similarity in learning styles of fellows and faculty, revealing a dominance of observational learning styles (“assimilating” and “diverging”) that was consistent with pathology being a visual field. In contrast, residents showed dominance of “learn by doing” styles (“converging” and “accommodating”). Residents’ stratification by training year showed a scattered distribution with an upward trend toward “learn by doing” behavior. While the difference in styles between residents and faculty/fellows may be due to a generational gap, transition from medical school, or acquisition of technical skills required for grossing specimens, this is an opportunity for adopting blended learning models and active learning processes to cater to residents’ different styles and to allow for flexibility to use all styles as and when needed. Based on these findings, we hypothesize that partnering juniors and seniors with similar styles has a potential for successful mentorship and exploration of other psychometrics is recommended for further understanding and improvement of pathology training.