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Update Milestone content review
CCC: who, what, how
Assessment tools
3
Milestones are progressive
over time. There is no
prescribed speed.
Levels do not
correspond to PGY
or year in program.
Patient Care and Medical Knowledge Medical Knowledge
Ischemic Heart Disease Congenital Heart Disease
Cardiopulmonary Bypass, Myocardial
Protection and Temporary Circulatory
Support
End Stage Cardiopulmonary Disease
Valvular Disease
Great Vessel Disease General Competencies
Critical Care Professionalism – Ethics and Values; Personal
Accountability
Esophagus Practice Based Learning and Improvement –
Learning; Research and Teaching
Lung and Airway Interpersonal and Communication Skills
Chest Wall/Pleura/Mediastinum Systems Based Practice – Patient Safety;
Resource Allocation; Practice Management
Patient Care and Medical Knowledge Medical Knowledge
General Competencies
Professionalism – Ethics and Values; Personal
Accountability
Practice Based Learning and Improvement –
Learning; Research and Teaching
Interpersonal and Communication Skills
Systems Based Practice – Patient Safety;
Resource Allocation; Practice Management
Residents are not required or expected to reach
Level 5 by the end of training.
When selecting the best Level for a resident
◦ Selecting a middle box implies that all milestones
in that level and in lower levels have been
attained.
Selecting between levels
◦ all milestones in lower levels have been
attained as well as some milestones in the higher
level(s).
7
Thoracic Surgery Reporting Milestones Timeline
January 2014 April 2014 July 2014 October 2014
Jan-Mar 2014
-Form CCC, meet,
review & selects
assessment tools
-Develop new tools
to fill any
assessment gaps
Jul –Nov 2014
Perform assessments and
collect data Nov-Dec 2013
CCC meets and
assigns Milestones
July 1, 2014
TS Milestone Begin
January 2015
1st Milestones
document due
to ACGME
ACGME expects programs to implement Subspecialty
Reporting Milestones for AY 2014-2015
We are here…
Apr-Jun 2014
-CCC meets mo
-Implement tools,
Beta test, make
adjustments
.
Surgical Specialty Milestones
Specialty # Milestones Faculty
Development
Congenital Cardiac 9 +++
General Surgery 16 0
Otolaryngology 17 0
Colorectal 20 0
Neurosurgery 24 0
Pediatric Surgery 24 0
Thoracic 26 +++
Plastics* 30 0
Vascular 31 0
Urology 32 +
Orthopedic* 40 0
MEAN 24
Chair
Program
Coordinator
PD/
Assoc PD
Core Teaching/
Advisory Faculty
Clinical
Chair/Chief
Chief
Residents
CCC Team
●Limit the size (4-6)
●Broad representation of
Disciplines, experience,
locations
Non-faculty (e.g. RN’s, mid-
levels, perfusionists)
Educators (PhD, RN)
●Review/develop/implement assessment tools
●Review trainee portfolios
●Enforce completion of assessment data
●Review assessment data for accuracy
●Assign milestone levels for each trainee
biannually
●Develop remediation strategies
●Review faculty and trainee surveys, peer
evaluations
●Review current assessment tools and
find strengths and weaknesses
●Implement assessment tools that are
practical with maximal faculty
compliance
●Intervention strategies for struggling
residents/remediation plans
●Provide career development
●Everyone must buy in
●Improve timeliness and quality of
evals/feedback
●All members need to be fair
●Implement assessment tools that are
practical with maximal faculty compliance
●Intervention strategies for struggling
residents/remediation plans
●Provide career development
●Each CCC member is responsible for
one trainee (their assigned mentee) –
best for small programs
●Each CCC member is responsible for
one or more competencies for all
trainees
●All CCC members review all
assessment data for all trainees and
come to milestone level consensus
• Summative Assessment and Feedback
• Data/ Assessment System Development
• Assessment Methods and Validation
• Program Review and Development
Mapping experiences
Faculty/resident development
Educate
leadership
Develop/Adopt Systems
Pilot testing
Study for validity
Provide feedback
Remediation
Develop assessment curricula
Modify educational
experiences
Data manager
Professional development
Reporting mechanism
Selecting/developing effective assessment
tools
Incorporating milestone assessments
Subgrouping PGY years
Faculty development
Individualize curriculum
Time commitment
Domain Ave Time
(hrs/resident)
Program Review/Devt 17.3
Assessment
Methods/Validation
12.4
Data System Devt 6.6
Summative
Assessment/Feedback
18.3
Total 54.6
Milestones and evaluation principles
Integrating/synthesizing data
Providing timely and appropriate feedback
Thresholds of concern
Are meetings and practices “peer
protected”
Meeting minutes: Discoverable
How will differences between CCC
chair/ members /PD be managed
What is the appeals process
●Formative feedback and summative
evaluation of trainees
●Resident promotion decisions
●Curriculum and educational program
assessment and improvement
●Educational research
Admin home
User home
Admin home
User home
#1: Dependent on your Institution’s Graduate
Medical Committee
Being able to import and show summary data
from evaluations/tools
Generate simple counts of how many evaluators
chose a certain answer to a certain question
Connect evaluation questions to Milestones
reports: by competency, unique questions,
and/or directly verbatim
Direct observation
Case logs
Structured case discussion
Oral exams
Video assessments
Simulation
Direct observation
Pt survey
Video assessments
Simulation
Direct observation
Chart review
Pt survey
Oral exams
Video assessments
Simulation
ITS
Structured case discussion
Oral exams
Video assessment
Simulation
Moodle exams
Chart review
Case logs
Patient outcomes
Direct observation
360 assessment
Chart review
Structured case discussions
Video assessments
Record Review
Chart Stimulation
Recall
Check List
Global Rating
Standardized Patients
OSCE/ CASPE
Simulations and
Models
360 Global Rating
Learning Portfolios
ITE
Mock Oral Exam
Procedures and Case
Logs
Patient Survey
SESATS
Moodle Courses
TSC Curriculum and
Modules
Simulation / Video
Assessment
Database Patient
Outcomes
Observation of Patient
Encounters
Presentation skills
Patient evaluation
QI Review
Residents as educator
Chart audit
Implementation July 1, 2014
Documentation Jan 1, 2015
Program coordinator support is most critical
Semi-annual assessment of residents by CCC
Select and implement assessment tools
Faculty buy-in and development
Various methods in mapping and housing
assessments to the Milestones in development
