title: Practicing emergency physicians report performing well on most emergency medicine milestones.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education's Next Accreditation System endorsed specialty-specific milestones as the foundation of an outcomes-based resident evaluation process. These milestones represent five competency levels (entry level to expert), and graduating residents will be expected to meet Level 4 on all 23 milestones. Limited validation data on these milestones exist. It is unclear if higher levels represent true competencies of practicing emergency medicine (EM) attendings.
  
  
  OBJECTIVE
  Our aim was to examine how practicing EM attendings in academic and community settings self-evaluate on the new EM milestones.
  
  
  METHODS
  An electronic self-evaluation survey outlining 9 of the 23 EM milestones was sent to a sample of practicing EM attendings in academic and community settings. Attendings were asked to identify which level was appropriate for them.
  
  
  RESULTS
  Seventy-nine attendings were surveyed, with an 89% response rate. Sixty-one percent were academic. Twenty-three percent (95% confidence interval [CI] 20%-27%) of all responses were Levels 1, 2, or 3; 38% (95% CI 34%-42%) were Level 4; and 39% (95% CI 35%-43%) were Level 5. Seventy-seven percent of attendings found themselves to be Level 4 or 5 in eight of nine milestones. Only 47% found themselves to be Level 4 or 5 in ultrasound skills (p = 0.0001).
  
  
  CONCLUSIONS
  Although a majority of EM attendings reported meeting Level 4 milestones, many felt they did not meet Level 4 criteria. Attendings report less perceived competence in ultrasound skills than other milestones. It is unclear if self-assessments reflect the true competency of practicing attendings. The study design can be useful to define the accuracy, precision, and validity of milestones for any medical field.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Peck
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Nicole
authors.initials: N
authors.lastname: Dubosh
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Carlo
authors.initials: C
authors.lastname: Rosen
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Carrie
authors.initials: C
authors.lastname: Tibbles
authors.affiliation: Emergency Medicine Department, St Luke's Hospital, New Bedford, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pope
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fisher
mesh_terms: D000068:Accreditation / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D011446:Prospective Studies
keywords: ACGME; Next Accreditation System; emergency medicine milestones; graduate medical education; resident evaluation