Heath Janae K, Dine C Jessica
J Grad Med Educ. 2019 Feb;11(1):53-59. doi: 10.4300/JGME-D-18-00308.1.
The Accreditation Council for Graduate Medical Education Milestones were created as a criterion-based framework to promote competency-based education during graduate medical education. Despite widespread implementation across subspecialty programs, extensive validity evidence supporting the use of milestones within fellowship training is lacking.
We assessed the construct and response process validity of milestones in subspecialty fellowship programs in an academic medical center.
From 2014-2016, we performed a single center retrospective cohort analysis of milestone data from fellows across 5 programs. We analyzed summary statistics and performed multivariable linear regression to assess change in milestone ratings by training year and variability in ratings across fellowship programs. Finally, we examined a subset of Professionalism and Interpersonal and Communication Skills subcompetencies from the first 6 months of training to identify the proportion of fellows deemed "ready for independent practice" in these domains.
Milestone data were available for 68 fellows, with 75 933 unique subcompetency ratings. Multivariable linear regression, adjusted for subcompetency and subspecialty, revealed an increase of 0.17 (0.16-0.19) in ratings with each postgraduate year level increase ( < .005), as well as significant variation in milestone ratings across subspecialties. For the Professionalism and Interpersonal and Communication Skills domains, mean ratings within the first 6 months of training were 3.78 and 3.95, respectively.
We noted a minimal upward trend of milestone ratings in subspecialty training programs, and significant variability in implementing milestones across differing subspecialties. This may suggest possible difficulties with the construct validity and response process of the milestone system in certain medical subspecialties.
研究生医学教育认证委员会里程碑标准是作为一个基于标准的框架而制定的，旨在促进研究生医学教育期间基于能力的教育。尽管该标准在各亚专业项目中得到了广泛实施，但在专科培训中支持使用这些里程碑标准的充分有效性证据仍然缺乏。
我们评估了一所学术医疗中心亚专业专科培训项目中里程碑标准的结构效度和反应过程效度。
2014年至2016年，我们对5个项目的学员的里程碑数据进行了单中心回顾性队列分析。我们分析了汇总统计数据，并进行了多变量线性回归，以评估里程碑评分随培训年份的变化以及各专科培训项目评分的变异性。最后，我们检查了培训前6个月中专业精神以及人际和沟通技能子能力的一个子集，以确定在这些领域中被认为“准备好独立执业”的学员比例。
有68名学员的里程碑数据可用，共有75933个独特的子能力评分。经子能力和亚专业调整后的多变量线性回归显示，随着研究生年级每升高一级，评分增加0.17（0.16 - 0.19）（P <.005），并且各亚专业的里程碑评分存在显著差异。对于专业精神以及人际和沟通技能领域，培训前6个月的平均评分分别为3.78和3.95。
我们注意到亚专业培训项目中里程碑评分有最小的上升趋势，并且在不同亚专业实施里程碑标准时存在显著差异。这可能表明在某些医学亚专业中，里程碑系统的结构效度和反应过程可能存在困难。
