title: Using Milestones as Evaluation Metrics During an Emergency Medicine Clerkship.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education's (ACGME) Milestones presumes graduating medical students will enter residency proficient at Milestone level 1 for 23 skills. The Next Accreditation System now includes Milestones for each postgraduate specialty, and it is unlikely that schools will document every emergency medicine (EM) applicant's EM-specific skills in their performance evaluation.
  
  
  OBJECTIVE
  The goals of this research were to determine if assessment of the Milestones was feasible during a medical student clerkship and examine the proportion of medical students performing at Milestone level 1.
  
  
  METHODS
  This study was conducted at a center with Liaison Committee on Medical Education-approved medical training and a 4-year EM residency. Using traditional clerkship, we studied the feasibility of an ACGME EM Milestones-based clerkship assessment. Data led to redesign of the clerkship and its evaluation process, including all level 1 anchor(s) to add "occasionally" (>60%), "usually" (>80%), and "always" (100%) on a Likert scale to on-shift assessment forms.
  
  
  RESULTS
  During the feasibility phase (2013-14), 75 students rotated though the clerkship; 55 evaluations were issued and 50 contained the Milestone summary. Eight deficiencies were noted in Milestone 12 and three in Milestone 14. After changes, 49 students rotated under the new evaluation rubric. Of 575 completed on-shift evaluations, 16 Milestone deficiencies were noted. Of 41 institutional evaluations issued, only one student had deficiencies noted, all of which pertained to patient care. All evaluations in this second cohort contained each student's Milestone proficiency.
  
  
  CONCLUSIONS
  Assessment of the Milestones is feasible. Communication of ACGME EM Milestone proficiency may identify students who require early observation or remediation. The majority of students meet the anchors for the Milestones, suggesting that clerkship assessment with the ACGME EM Milestones does not adequately differentiate students.
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Quinn
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Worrilow
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Deepak A
authors.initials: DA
authors.lastname: Jayant
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Blake
authors.initials: B
authors.lastname: Bailey
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Eric
authors.initials: E
authors.lastname: Eustice
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Jared
authors.initials: J
authors.lastname: Kohlhepp
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Ryan
authors.initials: R
authors.lastname: Rogers
authors.affiliation: Department of Emergency Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Kane
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D005240:Feasibility Studies; D006801:Humans
keywords: clerkship evaluation; curricular innovations; milestones