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Longitudinal Milestone Assessment Extending Through Subspecialty Training: The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones.

Publication ,  Journal Article
Heath, JK; Wang, T; Santhosh, L; Denson, JL; Holmboe, E; Yamazaki, K; Clay, AS; Carlos, WG
Published in: Acad Med
November 1, 2021

PURPOSE: Accreditation Council for Graduate Medical Education (ACGME) milestones were implemented across medical subspecialties in 2015. Although milestones were proposed as a longitudinal assessment tool potentially providing opportunities for early implementation of individualized fellowship learning plans, the association of subspecialty fellowship ratings with prior residency ratings remains unclear. This study aimed to assess the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones. METHOD: A multicenter retrospective cohort analysis was conducted for all PCCM trainees in ACGME-accredited PCCM fellowship programs, 2017-2018, who had complete prior IM milestone ratings from 2014 to 2017. Only professionalism and interpersonal and communication skills (ICS) were included based on shared anchors between IM and PCCM milestones. Using a generalized estimating equations model, the association of PCCM milestones ≤ 2.5 during the first fellowship year with corresponding IM subcompetencies was assessed at each time point, nested by program. Statistical significance was determined using logistic regression. RESULTS: The study included 354 unique PCCM fellows. For ICS and professionalism subcompetencies, fellows with higher IM ratings were less likely to obtain PCCM ratings ≤ 2.5 during the first fellowship year. Each ICS subcompetency was significantly associated with future lapses in fellowship (ICS01: β = -0.67, P = .003; ICS02: β = -0.70, P = .001; ICS03: β = -0.60, P = .004) at various residency time points. Similar associations were noted for PROF03 (β = -0.57, P = .007). CONCLUSIONS: Findings demonstrated an association between IM milestone ratings and low milestone ratings during PCCM fellowship. IM trainees with low ratings in several professionalism and ICS subcompetencies were more likely to be rated ≤ 2.5 during the first PCCM fellowship year. This highlights a potential use of longitudinal milestones to target educational gaps at the beginning of PCCM fellowship.

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Published In

Acad Med

DOI

EISSN

1938-808X

Publication Date

November 1, 2021

Volume

96

Issue

11

Start / End Page

1603 / 1608

Location

United States

Related Subject Headings

  • Social Skills
  • Retrospective Studies
  • Pulmonary Medicine
  • Male
  • Logistic Models
  • Internship and Residency
  • Internal Medicine
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Heath, J. K., Wang, T., Santhosh, L., Denson, J. L., Holmboe, E., Yamazaki, K., … Carlos, W. G. (2021). Longitudinal Milestone Assessment Extending Through Subspecialty Training: The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones. Acad Med, 96(11), 1603–1608. https://doi.org/10.1097/ACM.0000000000004165
Heath, Janae K., Tisha Wang, Lekshmi Santhosh, Joshua L. Denson, Eric Holmboe, Kenji Yamazaki, Alison S. Clay, and W Graham Carlos. “Longitudinal Milestone Assessment Extending Through Subspecialty Training: The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones.Acad Med 96, no. 11 (November 1, 2021): 1603–8. https://doi.org/10.1097/ACM.0000000000004165.

Published In

Acad Med

DOI

EISSN

1938-808X

Publication Date

November 1, 2021

Volume

96

Issue

11

Start / End Page

1603 / 1608

Location

United States

Related Subject Headings

  • Social Skills
  • Retrospective Studies
  • Pulmonary Medicine
  • Male
  • Logistic Models
  • Internship and Residency
  • Internal Medicine
  • Humans
  • General & Internal Medicine
  • Female