title: Competency milestones for medical students: Design, implementation, and analysis at one medical school.
abstract: Competency-based assessment seeks to align measures of performance directly with desired learning outcomes based upon the needs of patients and the healthcare system. Recognizing that assessment methods profoundly influence student motivation and effort, it is critical to measure all desired aspects of performance throughout an individual's medical training. The Accreditation Council for Graduate Medical Education (ACGME) defined domains of competency for residency; the subsequent Milestones Project seeks to describe each learner's progress toward competence within each domain. Because the various clinical disciplines defined unique competencies and milestones within each domain, it is difficult for undergraduate medical education to adopt existing GME milestones language. This paper outlines the process undertaken by one medical school to design, implement and improve competency milestones for medical students. A team of assessment experts developed milestones for a set of focus competencies; these have now been monitored in medical students over two years. A unique digital dashboard enables individual, aggregate and longitudinal views of student progress by domain. Validation and continuous quality improvement cycles are based upon expert review, user feedback, and analysis of variation between students and between assessors. Experience to date indicates that milestone-based assessment has significant potential to guide the development of medical students.
authors.affiliation: a Office of Undergraduate Medical Education, Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Lomis
authors.affiliation: a Office of Undergraduate Medical Education, Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Regina G
authors.initials: RG
authors.lastname: Russell
authors.affiliation: b Department of Biostatistics , Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Davidson
authors.affiliation: c Office of Medical Student Affairs, Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Fleming
authors.affiliation: a Office of Undergraduate Medical Education, Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Cathleen C
authors.initials: CC
authors.lastname: Pettepher
authors.affiliation: d Division of Pediatric Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Cutrer
authors.affiliation: d Division of Pediatric Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Fleming
authors.affiliation: e Office of Health Sciences Education, Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Miller
mesh_terms: D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D012577:Schools, Medical; D013337:Students, Medical