Minimum Milestone Achievement Expectations for Graduating Family Medicine Residents

Background and Objectives: The arrival of the Next Accreditation System and the ACGME Milestones heralded a new era in graduate medical education and resident assessment. The ACGME indicates that achievement of “Level 4” on the milestone subcompetencies is a graduation target and that ultimate graduation decisions rest with Program Directors. This study examined the utilization of the milestones in graduation decisions by Family Medicine residency programs. Methods: Family Medicine residency programs nationally were anonymously surveyed to determine the practices within their own programs as well as their understanding of what achievement of a “Level 4” meant. Surveys were sent to 555 unique Family Medicine programs via Survey Monkey. Results: The majority of Family Medicine residency programs surveyed did not require achievement of Level 4 in all subcompetencies in order to graduate, however there were some programs that did require this level of achievement. There were some programs (12%) that required achievement of “Level 4” in some of the subcompetencies. The most commonly identified subcompetencies in which this level of achievement was required resided under the Patient Care, Medical Knowledge and Professionalism competency umbrellas. Definition of “Level 4” varied between programs, with approximately half endorsing the ACGME-provided “graduation target” definition, while the remainder favored definitions ranging from “graduation requirement” to “competent.” Conclusions: Family Medicine residency programs utilize the ACGME milestones in different ways when making graduation decisions. There is varied opinion of how “Level 4” should be defined as well as varied milestone achievement requirements.