Harvard Medical School, Boston, Massachusetts.
Massachusetts General Hospital, Boston.
JAMA Netw Open. 2021 Dec 1;4(12):e2137179. doi: 10.1001/jamanetworkopen.2021.37179.
Longitudinal Milestones data reported to the Accreditation Council for Graduate Medical Education (ACGME) can be used to measure the developmental and educational progression of learners. Learning trajectories illustrate the pattern and rate at which learners acquire competencies toward unsupervised practice.
To investigate the reliability of learning trajectories and patterns of learning progression that can support meaningful intervention and remediation for residents.
DESIGN, SETTING, AND PARTICIPANTS: This national retrospective cohort study included Milestones data from residents in family medicine, representing 6 semi-annual reporting periods from July 2016 to June 2019.
Longitudinal formative assessment using the Milestones assessment system reported to the ACGME.
To estimate longitudinal consistency, growth rate reliability (GRR) and growth curve reliability (GCR) for 22 subcompetencies in the ACGME family medicine Milestones were used, incorporating clustering effects at the program level. Latent class growth curve models were used to examine longitudinal learning trajectories.
This study included Milestones ratings from 3872 residents in 514 programs. The Milestones reporting system reliably differentiated individual longitudinal patterns for formative purposes (mean [SD] GRR, 0.63 [0.03]); there was also evidence of precision for model-based rates of change (mean [SD] GCR, 0.91 [0.02]). Milestones ratings increased significantly across training years and reporting periods (mean [SD] of 0.55 [0.04] Milestones units per reporting period; P < .001); patterns of developmental progress varied by subcompetency. There were 3 or 4 distinct patterns of learning trajectories for each of the 22 subcompetencies. For example, for the professionalism subcompetency, residents were classified to 4 groups of learning trajectories; during the 3-year family medicine training period, trajectories diverged further after postgraduate year (PGY) 1, indicating a potential remediation point between the end of PGY 1 and the beginning of PGY 2 for struggling learners, who represented 16% of learners (620 residents). Similar inferences for learning trajectories were found for practice-based learning and improvement, systems-based practice, and interpersonal and communication skills. Subcompetencies in medical knowledge and patient care demonstrated more consistent patterns of upward growth.
These findings suggest that the Milestones reporting system provides reliable longitudinal data for individualized tracking of progress in all subcompetencies. Learning trajectories with supporting reliability evidence could be used to understand residents' developmental progress and tailored for individualized learning plans and remediation.
向研究生医学教育认证委员会 (ACGME) 报告的纵向里程碑数据可用于衡量学习者的发展和教育进展。学习轨迹说明了学习者在无监督实践中获得能力的模式和速度。
调查支持居民有意义干预和补救的学习轨迹和学习进展模式的可靠性。
设计、设置和参与者：这项全国性回顾性队列研究包括来自家庭医学住院医师的里程碑数据，代表 2016 年 7 月至 2019 年 6 月的 6 个半年度报告期。
使用里程碑评估系统进行纵向形成性评估，向 ACGME 报告。
使用 22 项家庭医学里程碑中的 22 项亚能力的纵向一致性、增长率可靠性 (GRR) 和增长曲线可靠性 (GCR) 进行估计，同时考虑了计划层面的聚类效应。潜在类别增长曲线模型用于检查纵向学习轨迹。
这项研究包括来自 514 个项目的 3872 名住院医师的里程碑评分。里程碑报告系统可靠地区分了形成性目的的个体纵向模式（平均 [SD] GRR，0.63 [0.03]）；对于基于模型的变化率也有证据表明具有精度（平均 [SD] GCR，0.91 [0.02]）。随着培训年限和报告期的增加，里程碑评分显着增加（每个报告期平均 [SD] 0.55 [0.04] 个里程碑单位；P < .001）；发展进度的模式因亚能力而异。对于 22 个亚能力中的每一个，都有 3 种或 4 种不同的学习轨迹模式。例如，对于专业精神亚能力，住院医师被分为 4 组学习轨迹；在家庭医学培训的 3 年期间，PGY1 后轨迹进一步发散，这表明挣扎学习者（占学习者的 16%（620 名住院医师））在 PGY1 结束和 PGY2 开始之间可能需要补救，这表明挣扎学习者（占学习者的 16%（620 名住院医师））在 PGY1 结束和 PGY2 开始之间可能需要补救。对于基于实践的学习和改进、基于系统的实践以及人际和沟通技能，也发现了类似的学习轨迹推论。医学知识和患者护理方面的亚能力表现出更一致的上升趋势。
这些发现表明，里程碑报告系统为所有亚能力的个人进度跟踪提供了可靠的纵向数据。具有支持可靠性证据的学习轨迹可用于了解居民的发展进度，并针对个性化学习计划和补救进行调整。
