Nabors Christopher, Peterson Stephen J, Forman Leanne, Stallings Gary W, Mumtaz Arif, Sule Sachin, Shah Tushar, Aronow Wilbert, Delorenzo Lawrence, Chandy Dipak, Lehrman Stuart G, Frishman William H, Holmboe Eric
J Grad Med Educ. 2013 Mar;5(1):130-7. doi: 10.4300/JGME-D-12-00130.1.
The internal medicine milestones were developed to advance outcomes-based residency training and will play an important role in the next accreditation system.
As an element of our program's participation in the internal medicine educational innovations project, we implemented a milestones-based evaluation process in our general medicine and pulmonary-critical care rotations on July 1, 2010.
Outcomes assessed included survey-rated acceptability to participating faculty, residents, and clinical competency committee members.
Faculty and residents agreed that the milestones promoted a common understanding of what knowledge, skills, and attitudes should be displayed at particular points in residents' professional development and enhanced evaluators' ability to provide specific performance feedback. Most residents and faculty members agreed that the milestones promoted fairness and uniformity in the evaluation process. Clinical competency committee members agreed the milestones improved the quality of information available for deliberations and resulted in more uniform promotion standards. Faculty rated the use of too many milestones per form/tool at a mean of 7.3 (where 1 was minimally problematic, and 10 was maximally problematic) and the potential for evaluator fatigue (mean, 8.2) as the most significant challenges to the use of milestones. Eight of 12 faculty members would recommend milestones in other programs; 4 were uncertain.
Despite logistical challenges, educators and trainees found that milestones promoted a common understanding of what knowledge, skills and attitudes should be displayed at particular stages of training; permitted greater specificity in performance feedback; and enhanced uniformity and fairness in promotion decisions.
制定内科专业里程碑是为了推进基于结果的住院医师培训，并将在下一版认证体系中发挥重要作用。
作为我们项目参与内科教育创新项目的一项内容，我们于2010年7月1日在普通内科和肺科-重症医学轮转培训中实施了基于里程碑的评估流程。
评估的结果包括参与项目的教员、住院医师和临床能力委员会成员通过调查评定的可接受性。
教员和住院医师一致认为，这些里程碑促进了对住院医师专业发展特定阶段应展现的知识、技能和态度的共同理解，并增强了评估者提供具体表现反馈的能力。大多数住院医师和教员认为，这些里程碑促进了评估过程的公平性和一致性。临床能力委员会成员一致认为，这些里程碑提高了可供审议的信息质量，并带来了更统一的晋升标准。教员认为每个表格/工具使用过多里程碑（平均评分为7.3，其中1表示问题最小，10表示问题最大）以及评估者疲劳的可能性（平均评分为8.2）是使用里程碑最显著的挑战。12名教员中有8名会向其他项目推荐使用里程碑；4名不确定。
尽管存在后勤方面的挑战，但教育工作者和学员发现，里程碑促进了对培训特定阶段应展现的知识、技能和态度的共同理解；使表现反馈更具针对性；并增强了晋升决策的一致性和公平性。
