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Milestones and Competency-based Medical Education

Milestones and Competency-based Medical Education. William Iobst, MD VP Academic Affairs ABIM. Competency-Based Medical Education. The International CMBE Collaborators 2009.

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Milestones and Competency-based Medical Education

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  1. Milestones and Competency-based Medical Education William Iobst, MD VP Academic Affairs ABIM

  2. Competency-Based Medical Education The International CMBE Collaborators 2009 is an outcomes-based approach to the design, implementation, assessment and evaluation of a medical education program using an organizing framework of competencies

  3. ACGME General Competencies • Medical knowledge • Patient care and procedural skills • Professionalism • Interpersonal and communication skills • Practice-based learning and improvement • Systems-based practice

  4. Competency • An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. The International CMBE Collaborators 2009

  5. Competent © 2010 Royal College and The International CBME Collaborators 5 Possessing the required abilities in all domains at a specified stage of medical education or practice Dyscompetent Relatively lacking in one or more domains of required abilities at a specified stage of medical education or practice Incompetent Lacking the required abilities in all domains in a certain context at a defined state of medical education or practice

  6. Traditional Framework • Time-based • Importance of “dwell time” and maturation within training program • Curricular/process-based • X number of months of training, or specific types of activities over defined period of time • Teacher-centered

  7. Carraccio, et al. 2002.

  8. Competency-based evaluation • Fundamental requirements: • You must know the trainee is truly competent to progress to the next stage of their career • Requires clear milestones defining competency • Requires reliable and valid assessment and evaluation

  9. Fully Competent A B C Finish PGY3 Start PGY1 Milestones and Trajectories A’ Lucey and Boote Milestones

  10. World Wide Interest in Reform • Tomorrow’s Doctors (UK) (1993) • The CanMEDS framework • The Outcomes Project • The Scottish Doctor • Good Medical Practice (UK) • the Australian Curriculum Framework for Junior Doctors • 2009 Framework for UGME in the Netherlands

  11. Reality in Training • 2001 – 2011 - The Doldrums of the Outcomes Project • Programs are having trouble moving from structure/process to competency/outcomes • Variable understanding of competencies by faculty • Difficulty assessing and evaluating competency

  12. The ACGME Milestones Initiative • All specialties to develop milestones and recommend assessments to advance CBME. • Define developmental milestones and reliable, valid assessment tools for all training programs by 2012!

  13. Milestones • By definition a milestone is a significant point in development. • Milestones should enable the trainee and program to know an individuals trajectory of competency acquisition. • Milestones should allow for the demonstration of competence in those activities that define the profession. • Assessment and evaluation using milestones must resonate with faculty.

  14. Value of Milestones Guide curriculum development and suggest assessment and evaluation strategies Guide resident self-assessment Allow competence-based promotion Assist remediation by highlighting specific deficits Achieve standardization in evaluation Drive GME reform Improve public accountability

  15. The IM Milestones • Organized by competency and competency sub-divisions • Framed in behavioral terms (Competence is observed in practice!) that define knowledge, skills, attitudes and behaviors • Linked with potential assessment tools

  16. Patient Care RRC sub-bullet

  17. Milestones Criticisms • Milestones are reductionistic • Checking off a milestones list does not equal competent practice in a highly complex health care environment • There are 142 internal medicine milestones Programs can not assess them all • Even over three years!

  18. Milestones Benefits • Provide the learner with a clear blue print of progression. There are no surprises. • Allow for rich formative feedback. Learners know where they are and where they need to go. • Define specific behaviors that can focus assessment.

  19. Milestone Challenges Insure that assessment and evaluation of milestones demonstrate competence in those activities that define the profession. More than just a check list! Must resonate with learners, clinician educators, and the public. One implementation strategy involves building assessment and evaluation around activities learners are “entrusted” to do.

  20. The Cardiology Milestones Putting Theory to Practice

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