title: Milestones: a rapid assessment method for the Clinical Competency Committee.
abstract: BACKGROUND
  Educational milestones are now used to assess the developmental progress of all U.S. graduate medical residents during training. Twice annually, each program's Clinical Competency Committee (CCC) makes these determinations and reports its findings to the Accreditation Council for Graduate Medical Education (ACGME). The ideal way to conduct the CCC is not known. After finding that deliberations reliant upon the new milestones were time intensive, our internal medicine residency program tested an approach designed to produce rapid but accurate assessments.
  
  
  METHODS
  For this study, we modified our usual CCC process to include pre-meeting faculty ratings of resident milestones progress with in-meeting reconciliation of their ratings. Data were considered largely via standard report and presented in a pre-arranged pattern. Participants were surveyed regarding their perceptions of data management strategies and use of milestones. Reliability of competence assessments was estimated by comparing pre-/post-intervention class rank lists produced by individual committee members with amasterclass rank list produced by the collective CCC after full deliberation.
  
  
  RESULTS
  Use of the study CCC approach reduced committee deliberation time from 25 min to 9 min per resident (p< 0.001). Committee members believed milestones improved their ability to identify and assess expected elements of competency development (p= 0.026). Individual committee member assessments of trainee progress agreed well with collective CCC assessments.
  
  
  CONCLUSIONS
  Modification of the clinical competency process to include pre-meeting competence ratings with in-meeting reconciliation of these ratings led to shorter deliberation times, improved evaluator satisfaction and resulted in reliable milestone assessments.
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nabors
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Leanne
authors.initials: L
authors.lastname: Forman
authors.affiliation: Department of Medicine, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Peterson
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Gennarelli
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: DeLorenzo
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Dipak
authors.initials: D
authors.lastname: Chandy
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Sule
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Stallings
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, New York, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
keywords: clinical competency committee; educational milestones