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. 2020 Jan 1;28(1):e1-e8.
doi: 10.5435/JAAOS-D-18-00786.

Orthopaedic Surgery Residency Milestones: Initial Formulation and Future Directions

S Elizabeth Ames  1 , Brent A Ponce, J Lawrence Marsh, Stanley J Hamstra
Affiliations

Orthopaedic Surgery Residency Milestones: Initial Formulation and Future Directions

S Elizabeth Ames et al. J Am Acad Orthop Surg. .

Abstract

Milestones specific to orthopaedic surgical training document individual resident progress through skill development in multiple dimensions. Residents increasingly interact with and are assessed by surgeons in both academic and private practice environments. Milestones describe the skills that support competence. One of the primary goals of milestones is to provide continuous data for educational quality improvement of residency programs. They provide a dialogue between surgeons who supervise residents or fellows and the program's Clinical Competency Committee throughout a resident's education. The orthopaedic milestones were developed jointly by the Accreditation Council for Graduate Medical Education and the American Board of Orthopaedic Surgery. The working team was designed with broad representation within the specialty. The milestones were introduced to orthopaedic residencies in 2013. Orthopaedics is a 5-year training program; the first comprehensive longitudinal data set is now available for study. This summary provides historical perspective on the development of the milestones, state of current milestone implementation, attempts to establish validity, challenges with the milestones, and the development of next-generation assessment tools.

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Figures

Figure 1
Figure 1
Excerpt from the 2016 Milestones Annual Report. This figure shows the wide range of attainment of milestones by subcompetency in orthopaedic surgery. Gaps in curriculum and widespread availability of effective assessment tools are thought to be notable contributors to the observed variation in these early findings, although true variation in resident competence cannot be ruled out. These early data represent useful information for making improvements in graduate medical education, in accordance with Deming's proposition for the value of variance in CQI. Data are shown for only the first 12 patient care subcompetencies. Copyright 2016 Accreditation Council for Graduate Medical Education. Used with permission. See https://www.acgme.org/What-We-Do/Accreditation/Milestones/Resources. CQI = continuous quality improvement
See this image and copyright information in PMC

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