The Internal Medicine Reporting Milestones: Cross-sectional Description of Initial Implementation in US Residency Programs

Background: High-quality assessment of resident performance is needed to guide individual residents' development and ensure their preparedness to provide patient care. To facilitate this aim, reporting milestones are now required across all internal medicine (IM) residency programs. Objective: To describe initial milestone ratings for the population of IM residents by IM residency programs. Design: Cross-sectional study. Setting: IM residency programs. Participants: All IM residents whose residency program directors submitted milestone data at the end of the 2013-2014 academic year. Measurements: Ratings addressed 6 competencies and 22 subcompetencies. A rating of not assessable indicated insufficient information to evaluate the given subcompetency. Descriptive statistics were calculated to describe ratings across competencies and training years. Results: Data were available for all 21 774 U.S. IM residents from all 383 programs. Overall, 2889 residents (1621 in postgraduate year 1 [PGY-1], 902 in PGY-2, and 366 in PGY-3) had at least 1 subcompetency rated as not assessable. Summaries of average ratings by competency and training year showed higher ratings for PGY-3 residents in all competencies. Overall ratings for each of the 6 individual competencies showed that fewer than 1% of third-year residents were rated as unsatisfactory or conditional on improvement. However, when subcompetency milestone ratings were used, 861 residents (12.8%) who successfully completed training had at least 1 competency with all corresponding subcompetencies graded below the threshold of readiness for unsupervised practice. Limitation: Data were derived from a point in time in the first reporting period in which milestones were used. Conclusion: The initial milestone-based evaluations of IM residents nationally suggest that documenting developmental progression of competency is possible over training years. Subcompetencies may identify areas in which residents might benefit from additional feedback and experience. Future work is needed to explore how milestones are used to support residents' development and enhance residency curricula.