title: Placing constraints on the use of the ACGME milestones: a commentary on the limitations of global performance ratings.
abstract: As part of the outcomes-based accreditation process, the Accreditation Council for Graduate Medical Education (ACGME) now requires that medical specialties formulate and use educational milestones to assess residents' performance. These milestones are specialty-specific achievements that residents are expected to demonstrate at established intervals in their training. In this Commentary, the authors argue that the pressure to efficiently use program directors' and faculty members' time, particularly in the increasingly clinical-revenue-dependent model of the academic medical center, will lead program directors to meet these new accreditation expectations solely by adding items that assess these competencies to global end-of-rotation rating forms. This approach will increase the workload of faculty but will not provide new and useful information about residents' competence. These same concerns could apply if assessment committees attempt to measure these new performance dimensions without using direct observation to evaluate residents' performance. In these circumstances, the milestones movement will fall short of its intention and potential. In this Commentary, the authors outline and provide evidence from the literature for their concerns. They discuss the role that human judges play in measuring performance, the measurement characteristics of global performance ratings, and the problems associated with simply adding items to existing global rating forms.
authors.affiliation: Dr. Williams is adjunct professor of surgery, Indiana University School of Medicine, Indianapolis, Indiana, and J. Roland Folse, MD, Professor of Surgical Education Research and Development Emeritus, Southern Illinois University School of Medicine, Springfield, Illinois. He served as a member of the General Surgery Milestones Development Committee. Dr. Dunnington is chairman, Department of Surgery, and Jay L. Grosfeld Professor of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. He served as a member of the committee that developed the original ACGME competencies. Dr. Mellinger is J. Roland Folse, MD, Chair and professor, Division of General Surgery, and program director, General Surgery Residency Program, Southern Illinois University School of Medicine, Springfield, Illinois. Dr. Klamen is associate dean for education and curriculum and chair, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Reed G
authors.initials: RG
authors.lastname: Williams
authors.forename: Gary L
authors.initials: GL
authors.lastname: Dunnington
authors.forename: John D
authors.initials: JD
authors.lastname: Mellinger
authors.forename: Debra L
authors.initials: DL
authors.lastname: Klamen
mesh_terms: D003162:Competency-Based Education; D004501:Education, Medical / Q000379:methods*