Khalid Syed I, Mehta Ankit I, Atwal Gursant, Hogan Sean O, Park Yoon Soo, Charbel Fady T
1Department of Neurosurgery, University of Illinois Chicago.
2Accreditation Council for Graduate Medical Education, Chicago; and.
J Neurosurg. 2025 Jun 20:1-7. doi: 10.3171/2025.4.JNS243272.
The aim of this study was to evaluate milestone progression across 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies and 20 subcompetencies among neurosurgery residents, focusing on the attainment of level 4 proficiency by the final postgraduate year (PGY 7), and to identify patterns of co-occurring deficiencies.
A retrospective cohort analysis was conducted using national ACGME Milestone data from 2478 neurosurgery residents across 120 programs in the United States, covering 2018 to June 2022 evaluations. Semiannual milestone scores were analyzed using mean, standard deviation, median, and interquartile range. The proportion of residents not achieving level 4 by PGY 7 was assessed, and co-occurring deficiencies were identified through pairwise analysis and the variance-to-mean ratio (VMR).
Residents demonstrated significant progression from PGY 1 to PGY 7, with mean scores increasing from 1.2-1.7 in PGY 1 to 4.20-4.36 by PGY 7. By PGY 7, 445 of 997 residents (44.6%) had not achieved level 4 in at least one subcompetency. Patient Care (PC) had the highest proportion below level 4 (35.5%), particularly in specialized areas such as Surgical Treatment of Epilepsy and Movement Disorders (mean 4.08 ± 0.48) and Pain and Peripheral Nerve Disorders (mean 4.05 ± 0.49). Pairwise analysis revealed co-occurrences among specialized PC subcompetencies and between Reflective Practice and technical competencies. VMR analysis showed substantial variability in subcompetency attainment across programs.
Neurosurgery residents show robust milestone progression, yet gaps persist in specialized clinical skills and self-assessment practices, often aligning with subspecialties where fellowship training is common. Residency programs might need to enhance exposure or adjust competency expectations. Integrated educational strategies, including targeted interventions and specialized procedural training, are recommended to ensure all residents achieve level 4 competency, preparing them for independent practice.
本研究旨在评估神经外科住院医师在6项毕业后医学教育认证委员会（ACGME）核心能力和20项亚能力方面的里程碑式进展，重点关注在研究生最后一年（PGY 7）达到4级熟练程度的情况，并识别同时出现的不足之处。
使用来自美国120个项目的2478名神经外科住院医师的全国ACGME里程碑数据进行回顾性队列分析，涵盖2018年至2022年6月的评估。使用均值、标准差、中位数和四分位间距分析半年一次的里程碑分数。评估到PGY 7时未达到4级的住院医师比例，并通过成对分析和方差均值比（VMR）识别同时出现的不足之处。
住院医师从PGY 1到PGY 7有显著进展，平均分数从PGY 1时的1.2 - 1.7提高到PGY 7时的4.20 - 4.36。到PGY 7时，997名住院医师中有445名（44.6%）在至少一项亚能力方面未达到4级。患者护理（PC）在4级以下的比例最高（35.5%），特别是在癫痫和运动障碍的外科治疗（均值4.08±0.48）以及疼痛和周围神经疾病（均值4.05±0.49）等专业领域。成对分析揭示了专业PC亚能力之间以及反思性实践与技术能力之间的同时出现情况。VMR分析显示各项目在亚能力达成方面存在很大差异。
神经外科住院医师显示出强劲的里程碑式进展，但在专业临床技能和自我评估实践方面仍存在差距，这些差距通常与常见专科培训的亚专业相关。住院医师培训项目可能需要增加接触机会或调整能力期望。建议采用综合教育策略，包括有针对性的干预措施和专门的程序培训，以确保所有住院医师达到4级能力，为他们的独立实践做好准备。
