J.K. Heath is assistant professor, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0533-3088 .
T. Wang is associate professor, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Acad Med. 2021 Nov 1;96(11):1603-1608. doi: 10.1097/ACM.0000000000004165.
Accreditation Council for Graduate Medical Education (ACGME) milestones were implemented across medical subspecialties in 2015. Although milestones were proposed as a longitudinal assessment tool potentially providing opportunities for early implementation of individualized fellowship learning plans, the association of subspecialty fellowship ratings with prior residency ratings remains unclear. This study aimed to assess the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones.
A multicenter retrospective cohort analysis was conducted for all PCCM trainees in ACGME-accredited PCCM fellowship programs, 2017-2018, who had complete prior IM milestone ratings from 2014 to 2017. Only professionalism and interpersonal and communication skills (ICS) were included based on shared anchors between IM and PCCM milestones. Using a generalized estimating equations model, the association of PCCM milestones ≤ 2.5 during the first fellowship year with corresponding IM subcompetencies was assessed at each time point, nested by program. Statistical significance was determined using logistic regression.
The study included 354 unique PCCM fellows. For ICS and professionalism subcompetencies, fellows with higher IM ratings were less likely to obtain PCCM ratings ≤ 2.5 during the first fellowship year. Each ICS subcompetency was significantly associated with future lapses in fellowship (ICS01: β = -0.67, P = .003; ICS02: β = -0.70, P = .001; ICS03: β = -0.60, P = .004) at various residency time points. Similar associations were noted for PROF03 (β = -0.57, P = .007).
Findings demonstrated an association between IM milestone ratings and low milestone ratings during PCCM fellowship. IM trainees with low ratings in several professionalism and ICS subcompetencies were more likely to be rated ≤ 2.5 during the first PCCM fellowship year. This highlights a potential use of longitudinal milestones to target educational gaps at the beginning of PCCM fellowship.
研究生医学教育认证委员会 (ACGME) 的里程碑于 2015 年在各个医学亚专业中实施。尽管里程碑被提议作为一种潜在的纵向评估工具，为个体化 fellowship学习计划的早期实施提供机会，但亚专业 fellowship 评级与先前居住评级的关联仍不清楚。本研究旨在评估内科 (IM) 居住里程碑与肺和重症监护医学 (PCCM) 奖学金里程碑之间的关系。
对 2017-2018 年在 ACGME 认可的 PCCM 奖学金项目中接受培训的所有 PCCM 学员进行了一项多中心回顾性队列分析，这些学员在 2014 年至 2017 年期间有完整的 IM 里程碑评分。仅包括专业精神和人际沟通技巧 (ICS)，因为 IM 和 PCCM 里程碑之间有共同的锚点。使用广义估计方程模型，评估第一年奖学金期间 PCCM 里程碑≤2.5 与相应的 IM 子能力在每个时间点的关联，嵌套在程序中。使用逻辑回归确定统计学意义。
研究纳入了 354 名独特的 PCCM 研究员。对于 ICS 和专业精神子能力，具有较高 IM 评分的研究员在第一年奖学金期间获得 PCCM 评分≤2.5 的可能性较小。每个 ICS 子能力与未来的 fellowship 失误显著相关（ICS01：β=-0.67，P=0.003；ICS02：β=-0.70，P=0.001；ICS03：β=-0.60，P=0.004）在不同的居住时间点。类似的关联也在 PROF03 中观察到（β=-0.57，P=0.007）。
研究结果表明，IM 里程碑评分与 PCCM 奖学金期间的低里程碑评分之间存在关联。在几个专业精神和 ICS 子能力中评分较低的 IM 学员在第一年 PCCM 奖学金期间更有可能被评为≤2.5。这凸显了使用纵向里程碑在 PCCM 奖学金开始时针对教育差距的潜在用途。
