title: Using the ACGME Milestones for Resident Self-Evaluation and Faculty Engagement.
abstract: BACKGROUND
  Since July 2014 General Surgery residency programs have been required to use the Accreditation Council for Graduate Medical Education milestones twice annually to assess the progress of their trainees. We felt this change was a great opportunity to use this new evaluation tool for resident self-assessment and to furthermore engage the faculty in the educational efforts of the program.
  
  
  METHODS
  We piloted the milestones with postgraduate year (PGY) II and IV residents during the 2013/2014 academic year to get faculty and residents acquainted with the instrument. In July 2014, we implemented the same protocol for all residents. Residents meet with their advisers quarterly. Two of these meetings are used for milestones assessment. The residents perform an independent self-evaluation and the adviser grades them independently. They discuss the evaluations focusing mainly on areas of greatest disagreement. The faculty member then presents the resident to the clinical competency committee (CCC) and the committee decides on the final scores and submits them to the Accreditation Council for Graduate Medical Education website. We stored all records anonymously in a MySQL database. We used Anova with Tukey post hoc analysis to evaluate differences between groups. We used intraclass correlation coefficients and Krippendorff's α to assess interrater reliability.
  
  
  RESULTS
  We analyzed evaluations for 44 residents. We created scale scores across all Likert items for each evaluation. We compared score differences by PGY level and raters (self, adviser, and CCC). We found highly significant increases of scores between most PGY levels (p < 0.05). There were no significant score differences per PGY level between the raters. The interrater reliability for the total score and 6 competency domains was very high (ICC: 0.87-0.98 and α: 0.84-0.97). Even though this milestone evaluation process added additional work for residents and faculty we had very good participation (93.9% by residents and 92.9% by faculty) and feedback was generally positive.
  
  
  CONCLUSIONS
  Even though implementation of the milestones has added additional work for general surgery residency programs, it has also opened opportunities to furthermore engage the residents in reflection and self-evaluation and to create additional venues for faculty to get involved with the educational process within the residency program. Using the adviser as the initial rater seems to correlate closely with the final CCC assessment. Self-evaluation by the resident is a requirement by the RRC and the milestones seem to be a good instrument to use for this purpose. Our early assessment suggests the milestones provide a useful instrument to track trainee progression through their residency.
authors.affiliation: Department of Surgery, Education Office, Upstate Medical University, Syracuse, New York. Electronic address: meieran@upstate.edu.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Meier
authors.affiliation: Department of Surgery, Education Office, Upstate Medical University, Syracuse, New York.
authors.forename: Angelika
authors.initials: A
authors.lastname: Gruessner
authors.affiliation: Department of Surgery, Education Office, Upstate Medical University, Syracuse, New York.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Cooney
mesh_terms: D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005180:Faculty, Medical / Q000458:organization & administration; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D015588:Observer Variation; D010865:Pilot Projects; D012189:Retrospective Studies; D012647:Self-Assessment; D014481:United States
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; faculty engagement; milestones; resident self-evaluation and reflection