title: Emergency Medicine Residents Consistently Rate Themselves Higher than Attending Assessments on ACGME Milestones.
abstract: BACKGROUND
  In 2012 the Accreditation Council for Graduate Medical Education (ACGME) introduced the Next Accreditation System (NAS), which implemented milestones to assess the competency of residents and fellows. While attending evaluation and feedback is crucial for resident development, perhaps equally important is a resident's self-assessment. If a resident does not accurately self-assess, clinical and professional progress may be compromised. The objective of our study was to compare emergency medicine (EM) resident milestone evaluation by EM faculty with the same resident's self-assessment.
  
  
  METHODS
  This is an observational, cross-sectional study that was performed at an academic, four-year EM residency program. Twenty-five randomly chosen residents completed milestone self-assessment using eight ACGME sub-competencies deemed by residency leadership as representative of core EM principles. These residents were also evaluated by 20 faculty members. The milestone levels were evaluated on a nine-point scale. We calculated the average difference between resident self-ratings and faculty ratings, and used sample t-tests to determine statistical significance of the difference in scores.
  
  
  RESULTS
  Eighteen residents evaluated themselves. Each resident was assessed by an average of 16 attendings (min=10, max=20). Residents gave themselves statistically significant higher milestone ratings than attendings did for each sub-competency examined (p<0.0001).
  
  
  CONCLUSIONS
  Residents over-estimated their abilities in every sub-competency assessed. This underscores the importance of feedback and assessment transparency. More attention needs to be paid to methods by which residency leadership can make residents' self-perception of their clinical ability more congruent with that of their teachers and evaluators. The major limitation of our study is small sample size of both residents and attendings.
authors.affiliation: Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
authors.forename: Katja
authors.initials: K
authors.lastname: Goldflam
authors.affiliation: Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bod
authors.affiliation: Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
authors.forename: David
authors.initials: D
authors.lastname: Della-Giustina
authors.affiliation: Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
authors.forename: Alina
authors.initials: A
authors.lastname: Tsyrulnik
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D003237:Connecticut; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education*; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency; D012647:Self-Assessment