Longitudinal Alignment of ACGME Milestones for General Surgery Residency and Vascular Surgery Fellowship

Objective: To understand the residency to subspecialty fellowship transition by exploring the alignment of graduating general surgery and initial vascular surgery fellowship ACGME Milestones 2.0 within: (1) harmonized and (2) non-harmonized competencies. Background: The harmonization of Milestones 2.0 across specialties presents an opportunity to evaluate a trainee’s progression from residency through fellowship. Understanding the alignment between general surgery residency and vascular surgery fellowship is important to identify struggling learners earlier and explore this transition. Methods: This is a retrospective review of a national cohort of vascular surgery fellows (starting 2022 and 2023) who previously completed general surgery residency. We compared ACGME Milestones from the final 2 years of residency to the first year of fellowship using descriptive statistics and a mixed effects regression model. Results: Milestones data were collected for 266 vascular surgery fellows from 2021-2024. PGY-5 end-year compared to year-1 vascular surgery fellowship end-year Milestones found a coefficient of 0.20 for PC (P=0.004), 0.13 for MK (P=0.027), 0.23 for PROF (P<0.001), and 0.17 for ICS (P=0.01). SBP and PBLI were not significantly aligned for PGY-5 end-year. The matched subcompetencies showed similar significant alignments: 3 of 4 PC, 2/2 MK, 4/4 PROF, and 2/3 of ICS subcompetencies. Conclusions: There is significant alignment between graduating general surgery and year-1 vascular surgery Milestones for non-harmonized competencies, PC and MK, and 2 of 4 harmonized competencies: PROF and ICS. These findings add internal structure validity evidence to Milestones 2.0 with potential to use the residency-fellowship hand-off to institute early improvement efforts for trainees.