IMPLEMENTING THE FAMILY MEDICINE MILESTONES USING AN ITERATIVE, RAPID-CYCLE FEEDBACK PROCEDURE

Abstract

While competency-based evaluations have been used for years to assess resident physicians’ performance, specialty boards in the United States have recently developed new metrics that operationalize the six essential elements of clinical practice: patient care, medical knowledge, systembased practice, practice-based learning and improvement, professionalism, and communication. Collectively, these new metrics encompass the core competencies of the Accreditation Council for Graduate Medicine Education Milestones evaluation system. We describe a multi-year, multi-phase initiative to implement the Milestones standards in an academic family medicine setting. A curriculum assessment was performed to identify gaps. Instruments and processes were scrutinized, revised, and piloted. An iterative, rapid-cycle feedback procedure was employed to make continuous improvements and rectify identified deficiencies. Gaps were found in the areas of practice based learning and improvement, systems based practice, and the mechanisms for providing residents with performancerelated feedback. Instruments and processes were revised and piloted during the 2013-2014 academic year. Using a consensus-based, iterative, rapid-cycle approach toward adopting the Milestones criteria can result in an improved assessment system that better meets residents’ (and residency programs’) needs, tracks progress over time, and fulfills accreditation requirements.