title: Entrusting Observable Practice Activities and Milestones Over the 36 Months of an Internal Medicine Residency.
abstract: OBJECTIVE
  Competency-based medical education and milestone reporting have led to increased interest in work-based assessments using entrustment over time as an assessment framework. Little is known about data collected from these assessments during residency. This study describes the results of entrustment of discrete work-based skills over 36 months in the University of Cincinnati internal medicine (IM) residency program.
  
  
  METHODS
  Attending physician and peer/allied health assessors provided entrustment ratings of resident performance on work-based observable practice activities (OPAs) mapped to Accreditation Council for Graduate Medicine Education/American Board of Internal Medicine reporting milestones for IM. These data were translated into milestones data and tracked longitudinally. The authors analyzed data from this new entrustment system's first 36 months (July 2012-June 2015).
  
  
  RESULTS
  During the 36-month period, assessors made 364,728 milestone assessments (mapped from OPAs) of 189 residents. Residents received an annualized average of 83 assessment encounters, producing means of 3,987 milestone assessments and 4,325 words of narrative assessment. Mean entrustment ratings (range 1-5) from all assessors for all milestones rose from 2.46 for first-month residents to 3.92 for 36th-month residents (r = 0.9252, P < .001). Attending physicians' entrustment ratings were lower than peer/allied health assessors' ratings. Medical knowledge and patient care milestones were rated lower than professionalism and interpersonal and communication skills milestones.
  
  
  CONCLUSIONS
  Entrustment of milestones appears to rise progressively over time, with differences by assessor type, competency, milestone, and resident. Further research is needed to elucidate the validity of these data in promotion, remediation, and reporting decisions.
authors.affiliation: E.J. Warm is Sue P. and Richard W. Vilter Professor of Medicine and categorical medicine program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.J.D. Held is assistant professor and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.M. Hellmann is a fellow in pulmonary/critical care, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.M. Kelleher is assistant professor and fellow in medical education, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.B. Kinnear is assistant professor and assistant program director, Medicine-Pediatrics, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.C. Lee is assistant professor and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.J.K. O'Toole is assistant professor and associate program director, Medicine-Pediatrics, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.B. Mathis is associate professor, associate chair for clinical affairs, and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.C. Mueller is professor and program director, Medicine-Pediatrics, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.D. Sall is assistant professor and fellow in medical education, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.J. Tolentino is visiting associate professor and program director, Medicine-Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York.D.P. Schauer is associate professor and associate program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Warm
authors.forename: Justin D
authors.initials: JD
authors.lastname: Held
authors.forename: Michael
authors.initials: M
authors.lastname: Hellmann
authors.forename: Matthew
authors.initials: M
authors.lastname: Kelleher
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kinnear
authors.forename: Caroline
authors.initials: C
authors.lastname: Lee
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: O'Toole
authors.forename: Bradley
authors.initials: B
authors.lastname: Mathis
authors.forename: Caroline
authors.initials: C
authors.lastname: Mueller
authors.forename: Dana
authors.initials: D
authors.lastname: Sall
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tolentino
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer