Using ACGME Milestones As a Formative Assessment for the Internal Medicine Clerkship: a Consecutive Two-year Outcome and Follow-up After Graduation

Overview

Journal BMC Med Educ

Publisher Biomed Central

Specialty Medical Education

Date 2024 Mar 5

PMID 38443912

Authors

Hsiao-Ju Lin

Jhong-Han Wu

Wei-Hung Lin

Kai-Wen Nien

Huei-Ting Wang

Pei-Jen Tsai

Chiung-Yu Chen

Affiliations

Soon will be listed here.

Abstract

Background: This study evaluated the utility of using Accreditation Council for Graduate Medical Education (ACGME) Milestones as a formative assessment tool for the fifth- and sixth-grade medical students' performance in their internal medicine (IM) clerkship and the same students' performance in their post-graduate year (PGY) IM training.

Methods: Retrospective data were collected from 65 medical students completing the two-year IM clerkship in the academic years 2019 and 2020 and 26 of the above students completing their PGY-1 training at the same university hospital in the academic year 2021. Data included the assessment results of 7 of the ACGME IM Milestones, information on admitted patients assigned to the students, and surveys of the students' satisfaction.

Results: The analysis included 390 assessment results during the IM clerkship and 78 assessment results during the PGY-1 training. Clinical teachers commonly rated level 3 to medical students in the IM clerkship, with PC-2 subcompetency receiving the lowest rating among seven subcompetencies. The levels of most subcompetencies showed stationary in the two-year IM clerkship. Significant improvement was observed in all subcompetencies during the PGY-1 training. The medical students in the second-year IM clerkship expressed higher satisfaction with implementing Milestones than in their first-year IM clerkship and perceived Milestones assessments' usefulness as learning feedback.

Conclusions: Using ACGME Milestones as a formative assessment tool in the IM clerkship yielded promising outcomes. Longitudinal follow-up of subcompetencies facilitated tracking students' development and providing constructive feedback.

References

Wancata L, Morgan H, Sandhu G, Santen S, Hughes D . Using the ACMGE Milestones as a Handover Tool From Medical School to Surgery Residency. J Surg Educ. 2016; 74(3):519-529. DOI: 10.1016/j.jsurg.2016.10.016. View

Press K, Bodurtha J . Milestones for medical students completing a clinical genetics elective. Genet Med. 2016; 19(2):236-239. DOI: 10.1038/gim.2016.89. View

Santen S, Peterson W, Khandelwal S, House J, Manthey D, Sozener C . Medical student milestones in emergency medicine. Acad Emerg Med. 2014; 21(8):905-11. DOI: 10.1111/acem.12443. View

Ochsmann E, Zier U, Drexler H, Schmid K . Well prepared for work? Junior doctors' self-assessment after medical education. BMC Med Educ. 2011; 11:99. PMC: 3267657. DOI: 10.1186/1472-6920-11-99. View

Pusic M, Boutis K, Hatala R, Cook D . Learning curves in health professions education. Acad Med. 2015; 90(8):1034-42. DOI: 10.1097/ACM.0000000000000681. View

Meyer E, Kelly W, Hemmer P, Pangaro L . The RIME Model Provides a Context for Entrustable Professional Activities Across Undergraduate Medical Education. Acad Med. 2018; 93(6):954. DOI: 10.1097/ACM.0000000000002211. View

Frank J, Snell L, Ten Cate O, Holmboe E, Carraccio C, Swing S . Competency-based medical education: theory to practice. Med Teach. 2010; 32(8):638-45. DOI: 10.3109/0142159X.2010.501190. View

Quinn S, Worrilow C, Jayant D, Bailey B, Eustice E, Kohlhepp J . Using Milestones as Evaluation Metrics During an Emergency Medicine Clerkship. J Emerg Med. 2016; 51(4):426-431. DOI: 10.1016/j.jemermed.2016.06.014. View

Eckstrand K, Potter J, Bayer C, Englander R . Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations. Acad Med. 2016; 91(7):930-5. PMC: 4925271. DOI: 10.1097/ACM.0000000000001088. View

10.

Green M, Aagaard E, Caverzagie K, Chick D, Holmboe E, Kane G . Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ. 2011; 1(1):5-20. PMC: 2931179. DOI: 10.4300/01.01.0003. View

11.

Holmboe E, Yamazaki K, Edgar L, Conforti L, Yaghmour N, Miller R . Reflections on the First 2 Years of Milestone Implementation. J Grad Med Educ. 2015; 7(3):506-11. PMC: 4597976. DOI: 10.4300/JGME-07-03-43. View

12.

Park Y, Hamstra S, Yamazaki K, Holmboe E . Longitudinal Reliability of Milestones-Based Learning Trajectories in Family Medicine Residents. JAMA Netw Open. 2021; 4(12):e2137179. PMC: 8652607. DOI: 10.1001/jamanetworkopen.2021.37179. View

13.

Lomis K, Russell R, Davidson M, Fleming A, Pettepher C, Cutrer W . Competency milestones for medical students: Design, implementation, and analysis at one medical school. Med Teach. 2017; 39(5):494-504. DOI: 10.1080/0142159X.2017.1299924. View

14.

Edgar L, Roberts S, Holmboe E . Milestones 2.0: A Step Forward. J Grad Med Educ. 2018; 10(3):367-369. PMC: 6008021. DOI: 10.4300/JGME-D-18-00372.1. View

15.

Beeson M, Hamstra S, Barton M, Yamazaki K, Counselman F, Shayne P . Straight Line Scoring by Clinical Competency Committees Using Emergency Medicine Milestones. J Grad Med Educ. 2017; 9(6):716-720. PMC: 5734325. DOI: 10.4300/JGME-D-17-00304.1. View

16.

Sheng W, Ho Y, Jenq C, Chuang C, Chen C, Tsai M . Longitudinal assessment of milestone development among internal medicine residents in Taiwan. J Formos Med Assoc. 2022; 121(11):2281-2287. DOI: 10.1016/j.jfma.2022.05.013. View

17.

Hauer K, Ten Cate O, Boscardin C, Irby D, Iobst W, OSullivan P . Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Health Sci Educ Theory Pract. 2013; 19(3):435-56. DOI: 10.1007/s10459-013-9474-4. View

18.

Amiel J, Andriole D, Biskobing D, Brown D, Cutrer W, Emery M . Revisiting the Core Entrustable Professional Activities for Entering Residency. Acad Med. 2021; 96(7S):S14-S21. DOI: 10.1097/ACM.0000000000004088. View

19.

Wall D, Bolshaw A, Carolan J . From undergraduate medical education to pre-registration house officer year: how prepared are students?. Med Teach. 2006; 28(5):435-9. DOI: 10.1080/01421590600625171. View