Program Director’s Corner – December 2021
Milestones 2.0 – They’re Here!
David C. Lieb, MD, Program Director, Endocrinology, Diabetes and Metabolism Fellowship, Eastern Virginia Medical School
It’s that time of year – everyone is in the holiday spirit, Spider-Man is swinging into theaters, and program directors across the country are working to complete their fellowship milestone evaluations. Milestones must be submitted through the ACGME Accreditation Data System (ADS) by January 14, 2022 – and this year is different. This year, it’s time for Milestones 2.0!
In full disclosure I was a member of the ACGME Endocrinology, Diabetes and Metabolism Milestones Work Group that helped to develop the new milestones. I’m proud of our work, and I hope that the changes that have been incorporated into the milestones are practical and helpful for program directors and Clinical Competency Committees (CCC) that are using them to evaluate their fellows’ progress. A link to the new Endocrine Milestones can be found here.
As per the ACGME, “the Milestones provide a framework for the assessment of the development of the fellow in key dimensions of the elements of physician competence in a…subspecialty”. The milestones are arranged into 5 levels – which are based upon the Dreyfus Five-Stage Developmental Model of Adult Skill Acquisition. The Dreyfus Model is all about how adults acquire skills – and fellows go through five stages, from novice, to competence, to proficiency, to expertise to mastery, on their road toward becoming the best endocrinologists they can be.
You can find a helpful 10-minute YouTube video here that explains the Dreyfus Model in some detail, with practical examples. It’s worth watching – and worth sharing with your fellows and faculty – especially those on your CCC. I’d recommend doing so prior to your CCC meeting, and before meeting with your fellows to review their Milestone progress. It’s important for both faculty and fellows to understand the framework upon which their evaluations are based – it makes them more useful. Fellows should understand their position as learners along a continuum, with developmental goals along their path. Faculty should realize that learners go through these stages – and evaluate, and teach, to each fellows’ current stage. Our role as program leaders is to help fellows move from stage to stage, and to help our faculty to recognize where each fellow is on their journey.
A nice review on the genesis of the original milestones, and the new milestones, can be found here. As this article explains, the initial milestones were limited by inconsistences and often utilized complicated, negative language. The new milestones were developed through focus groups and multiple interviews involving stakeholders (such as yourselves) – and we hope that Milestones 2.0 are more practical and more positive.
This page from the ACGME has resources that can help your CCC members, faculty and fellows to better understand, and more importantly, practically use the new milestones, for development and improvement. There are guidebooks for both fellows and for CCC members. I’d strongly recommend that you share these resources with your fellows and your CCC.
One of the most exciting resources is the new Supplemental Guide. The guide was created to provide examples for each of the milestones, that CCC members can use to assess their fellows. There are also recommended tools for assessment, with references and helpful information. I’d also strongly recommend sharing this guide with your CCC before your CCC milestone meeting. The goal is for your specific fellowship program, both faculty and fellows, to have a ‘shared mental model’ of the milestones. It also helps for fellows to have a more clear understanding of what is expect of them as they move through each developmental stage. Share the Supplemental Guide with them too – and use the examples as often as you can during rounds, in the clinic and during didactic.
Please don’t hesitate to reach out to me at liebdc@evms.edu with any questions or comments – the milestones are a central way for us to evaluate our fellows’ progress and development. I’m excited for this update and know that there will be more updates in the future. Your input is key. Let me know what you think!
Dr. David Lieb is chair of the APDEM Newsletter Committee.