Thread by @JonLimMD

The @acgme IM Milestones 2.0 were recently published and a new feature in this revision was the addition of a supplemental guide that the workgroups put together.

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acgme.org/Portals/0/PDFs…

#IMMilestones2 #meded #assessment

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The Supplemental Guide provides additional details and guidance for programs and learners alike to better understand the Milestones.

An improved shared mental model will hopefully lead to more successful implementation of this new assessment system.

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Here is the Milestone for Medical Knowledge 3: Knowledge of Diagnostic Testing

While the revisions from Milestones 1.0 to 2.0 provided greater clarity, reduced some complexity and avoided "education speak" jargon, they are still in broad terms for summative assessment.

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First, the Supplemental Guide offers examples of what might be observed in the workplace that would correlate to each Level within the Milestone.

Here you will see that Level 1, what would be expected for a beginning Intern includes knowledge learned in medical school.

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There is progression from common dx tests to complex dx testing-progression from testing in pts with common diseases to multisystem disease (increasing complexity).

Lvl 2 does not assume +ANA means autoimmune dz
Lvl 3 can interpret a +ANA within the clinical context
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In writing the Supplemental Guide, there were interesting differences based on various perspectives. What is common/complex in one region or hospital system may not be so in another. Prevalence of fungal diseases, TB, Lyme are just a few examples of regional differences.

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Given the specificity of expectations based on institution and patient population, the ACGME has posted a template for the Supplemental Guide that will allow programs to create their own examples and tailor a resource for their residents.

acgme.org/Specialties/Mi…

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Another feature of the Supplemental Guides are the resources for Assessment tools to help programs as they implement this new system.

Here are some example assessment tools for Patient Care 3 Clinical Reasoning, a new sub-competency in Milestones 2.0.

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Lastly, each subcompetency also has additional resources for programs and learners to reference. I think these are rich listings that can help programs assist learners to progress through their training.

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I'll end with a few suggestions for how the Supplemental Guide could be used. Please feel free to add any additional suggestions! @laura__edgar @boedudley @Midwest_MedPeds @CincyIM @DrBuckholdSLU @abbyWUim @AagaardEva @HeyladyMD @gretchendiemer @neilkotharimd @JanaeHeath1

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1) Assisting the Clinical Competency Committee Members, Program advising system to have a shared mental model for progression in training as a key tool in faculty development.

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2) Assisting clinical teaching faculty in faculty development to bolster their coaching, teaching, and assessment skills. A shared mental model will aide in more effective teaching with this growth mindset description and can provide specific examples for improvement.

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3) Helping residents in self-assessment as well as when working with their advisors to collaboratively reflect on their training. This tool could be a basis for co-producing the experiential learning with reflection between clinical coach and learner.

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