Dzara Kristina, Huth Kathleen, Kesselheim Jennifer C, Schumacher Daniel J
J Grad Med Educ. 2019 Aug;11(4):439-446. doi: 10.4300/JGME-D-18-00717.1.
Changes to assessment efforts following the shift to milestones-based assessment in the ACGME Next Accreditation System have not been fully characterized.
This study describes themes in initial milestones-based assessment practices with the goal of informing continued implementation and optimization of milestones-based assessment.
Semistructured interviews were conducted with 15 residency program leaders in 6 specialties at 8 academic medical centers between August and December 2016. We explored what was retained, what was added, and what was changed from pre-milestones assessment efforts. We also examined the perceived impact of the shift to milestones-based assessment on the programs. Thematic analysis began after the first 5 interviews and ended once thematic sufficiency was reached. Two additional authors reviewed the codes, offered critical input, and informed the formation and naming of the final themes.
Three themes were identified: (1) program leaders faced challenges to effective implementation; (2) program leaders focused on adaptability and making milestones work in what felt like a less than ideal situation for them; and (3) despite challenges, program leaders see value and utility in their efforts to move to milestones-based assessment. We describe a number of strategies that worked for programs during the transition, with perceived benefits acknowledged.
While adaptation to milestones has occurred and benefits are noted, negative impacts and challenges (eg, perceived lack of implementation guidance and faculty development resources) persist. There are important lessons learned (eg, utilizing implementation experiences formatively to improve curricula and assessment) in the transition to milestones-based assessment.
美国毕业后医学教育认证委员会（ACGME）下一版认证体系转向基于里程碑的评估后，评估工作的变化尚未得到充分描述。
本研究描述了基于里程碑的初始评估实践中的主题，旨在为基于里程碑的评估的持续实施和优化提供信息。
2016年8月至12月期间，对8所学术医疗中心6个专业的15名住院医师培训项目负责人进行了半结构化访谈。我们探讨了与里程碑前评估工作相比，哪些内容被保留、哪些被添加以及哪些发生了变化。我们还研究了转向基于里程碑的评估对这些项目的感知影响。在前5次访谈后开始进行主题分析，直至达到主题饱和。另外两位作者审查了编码，提供了关键意见，并为最终主题的形成和命名提供了信息。
确定了三个主题：（1）项目负责人在有效实施方面面临挑战；（2）项目负责人注重适应性，并努力在对他们来说不太理想的情况下使里程碑发挥作用；（3）尽管存在挑战，但项目负责人认为转向基于里程碑的评估是有价值和有用的。我们描述了一些在过渡期间对项目有效的策略，并认可了其感知到的益处。
虽然已经适应了里程碑并注意到了益处，但负面影响和挑战（例如，感觉缺乏实施指导和教师发展资源）仍然存在。在向基于里程碑的评估过渡过程中有重要的经验教训（例如，将实施经验形成性地用于改进课程和评估）。
