Introduction:
Accreditation Council for Graduate Medical Education (ACGME) milestones, implemented across medical subspecialties in 2015, were introduced as a longitudinal assessment tool to enhance individualized fellowship learning plans. The correlation between subspecialty fellowship ratings and prior residency ratings, however, has remained an area needing further understanding, especially within competitive fields like Acgme Critical Care Fellowship Programs. This study aims to evaluate the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones, providing valuable insights for ACGME critical care fellowship programs.
Methodology and Key Findings:
This multicenter retrospective cohort analysis included PCCM trainees in ACGME-accredited programs from 2017 to 2018, who had completed IM milestone ratings between 2014 and 2017. The study focused on professionalism, interpersonal and communication skills (ICS) subcompetencies due to their shared anchors across IM and PCCM milestones. Using a generalized estimating equations model, researchers assessed the association between IM subcompetencies and PCCM milestone ratings ≤ 2.5 during the first fellowship year, nested by program. The findings indicated a significant association: fellows with higher IM ratings in ICS and professionalism were less likely to receive PCCM ratings ≤ 2.5 during their initial fellowship year. Specifically, each ICS subcompetency (ICS01, ICS02, ICS03) and professionalism subcompetency PROF03 in IM were significantly associated with future performance indicators in fellowship.
Conclusion:
The study’s findings reveal a clear association between IM milestone ratings and subsequent low milestone ratings during PCCM fellowship, which is directly relevant to ACGME critical care fellowship programs. IM trainees demonstrating lower ratings in specific professionalism and ICS subcompetencies were found to be at a higher risk of receiving ratings ≤ 2.5 during their first year of PCCM fellowship. This underscores the potential utility of longitudinal milestone data in proactively identifying and addressing educational gaps early in ACGME critical care fellowship programs, allowing for targeted interventions to support trainee development from the outset.
