From Chrysalis to Taking Flight, the Metamorphosis of the ACGME During Dr Thomas Nasca's Tenure as CEO.

Thomas J. Nasca, MD, MACP, served as the President and Chief Executive Officer (CEO) of the Accreditation Council for Graduate Medical Education (ACGME) for 17 years, with his tenure ending December 2024. During this time he led and supported significant changes in accreditation and medical education.

Investigating the Roles and Impact of Clinical Competency Committees in Graduate Medical Education: A Narrative Review.

Although Clinical Competency Committees (CCCs) were implemented to facilitate the goals of competency-based medical education, implementation has been variable, and we do not know if and how these committees affected programs and assessment in graduate medical education (GME). To explore the roles CCCs fulfill in GME and their effect on trainees, faculty, and programs. We conducted a narrative review of CCC primary research with the following inclusion criteria: all articles must be research in nature, focused on GME and specifically studying CCCs, and published in English language journals from January 2013 to November 2022.

Predicting Performance in the Physical Medicine and Rehabilitation Part II Certification Oral Examination Based On Milestone Ratings.

The Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones to document learner development within a competency-based framework. On the other hand, board certifying examinations serve as a summative evaluation of a learner's readiness for independent medical practice. Scores in Part I of the American Board of Physical Medicine and Rehabilitation (ABPMR) examination, which measures medical knowledge, has been shown to correlate only with Milestones ratings in medical knowledge.

The Next Era of Assessment Within Medical Education: Exploring Intersections of Context and Implementation.

In competency-based medical education (CBME), which is being embraced globally, the patient-learner-educator encounter occurs in a highly complex context which contributes to a wide range of assessment outcomes. Current and historical barriers to considering context in assessment include the existing post-positivist epistemological stance that values objectivity and validity evidence over the variability introduced by context. This is most evident in standardized testing.

Are They Prepared? Comparing Intern Milestone Performance of Accelerated 3-Year and 4-Year Medical Graduates.

Purpose: Accelerated 3-year programs (A3YPs) at medical schools were developed to address student debt and mitigate workforce shortage issues. This study investigated whether medical school length (3 vs 4 years) was associated with early residency performance. The primary research question was as follows: Are the Accreditation Council for Graduate Medical Education Milestones (MS) attained by A3YP graduates comparable to graduates of traditional 4-year programs (T4YPs) at 6 and 12 months into internship?

Method: The MS data from students entering U.

The Predictive Performance of General Surgery Milestones on Post-Graduation Outcomes.

Objective: To establish whether Accreditation Council for Graduate Medical Education Milestones predict future performance of general surgery trainees.

Summary Background Data: Milestones provide bi-annual assessments of trainee progress across six competencies. It is unknown whether the Milestones predict surgeon performance after the transition to independent practice.

Trends in Operative Case Logs of Chief Residents in Surgery by Sex and Race: A 5-year National Study.

Objective: To examine case logs reported by general surgery residents and identify potential disparities in operative experience.

Background: A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents.

Programmatic Assessment of Clinical Reasoning: New Opportunities to Meet an Ongoing Challenge.

 Clinical reasoning is essential to physicians' competence, yet assessment of clinical reasoning remains a significant challenge. Clinical reasoning is a complex, evolving, non-linear, context-driven, and content-specific construct which arguably cannot be assessed at one point in time or with a single method. This has posed challenges for educators for many decades, despite significant development of individual assessment methods.

Accreditation Council for Graduate Medical Education Milestone Training Ratings and Surgeons' Early Outcomes.

Importance: National data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates.

Objective: To evaluate the association of in-training ACGME Milestone ratings in a surgical specialty with subsequent complication rates following a commonly performed operation, endovascular aortic aneurysm repair (EVAR).

Consensus-Derived Recommended Skills for Transition to Residency Courses.

Purpose: Transition to residency (TTR) courses facilitate the medical student-residency transition and are an integral part of senior medical student training. The authors established a common set of skills for TTR courses, and an expected level of entrustment students should demonstrate in each skill on TTR course completion.

Method: A modified Delphi approach was used with 3 survey iterations between 2020 and 2022 to establish skills to be included in a TTR course.

Data sharing and big data in health professions education: Ottawa consensus statement and recommendations for scholarship.

Changes in digital technology, increasing volume of data collection, and advances in methods have the potential to unleash the value of big data generated through the education of health professionals. Coupled with this potential are legitimate concerns about how data can be used or misused in ways that limit autonomy, equity, or harm stakeholders. This consensus statement is intended to address these issues by foregrounding the ethical imperatives for engaging with big data as well as the potential risks and challenges.

Accuracy of Entrustment-Based Assessment: Implications for Programs and Patients.

Although entrustment-supervision ratings are more intuitive compared to other rating scales, it is not known whether their use accurately assesses the appropriateness of care provided by a resident. To determine the frequency of incorrect entrustment ratings assigned by faculty and whether accuracy of an entrustment-supervision scale differed by resident performance when the scripted resident performance level is known. Faculty participants rated standardized residents in 10 videos using a 4-point entrustment-supervision scale.

Gender Differences in Work-Based Assessment Scores and Narrative Comments After Direct Observation.

Background: While some prior studies of work-based assessment (WBA) numeric ratings have not shown gender differences, they have been unable to account for the true performance of the resident or explore narrative differences by gender.

Objective: To explore gender differences in WBA ratings as well as narrative comments (when scripted performance was known).

Design: Secondary analysis of WBAs obtained from a randomized controlled trial of a longitudinal rater training intervention in 2018-2019.

Systems-Based Practice 20 Years On: Navigating the System for Better Care.

Systems-based practice (SBP) was introduced as 1 of 6 core competencies in 1999 because of its recognized importance in the quality and safety of health care provided to patients. Nearly 25 years later, faculty and learners continue to struggle with understanding and implementing this essential competency, thus hindering the medical education community's ability to most effectively teach and learn this important competency.Milestones were first introduced in 2013 as one effort to support implementation of the general competencies.

How a Team Effectiveness Approach to Health Systems Science Can Illuminate Undergraduate Medical Education Outcomes.

Health care delivery requires physicians to operate in teams to successfully navigate complexity in caring for patients and communities. The importance of training physicians early in core concepts of working in teams (i.e.

Learner Assessment and Program Evaluation: Supporting Precision Education.

Precision education (PE) systematically leverages data and advanced analytics to inform educational interventions that, in turn, promote meaningful learner outcomes. PE does this by incorporating analytic results back into the education continuum through continuous feedback cycles. These data-informed sequences of planning, learning, assessing, and adjusting foster competence and adaptive expertise.

Transition to Residency: National Study of Factors Contributing to Variability in Learner Milestones Ratings in Emergency Medicine and Family Medicine.

Purpose: The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident Milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM).

Industry Payments Received by Residents During Training.

Importance: Those responsible for medical education-specialties, sponsoring institutions, and program directors (PD)-are independently associated with the professional identity formation of the trainees with respect to potential conflicts of interest.

Objective: To identify the relative degree to which factors in the training environment are associated with resident acceptance of payments from pharmaceutical and medical device companies.

Design, Setting, And Participants: Cross-sectional, retrospective study of residents enrolled in the 3 largest primary-care specialties (internal medicine [IM], family medicine [FM], obstetrics and gynecology [OBGYN]) and 3 largest surgical disciplines (general surgery [GS], orthopedic surgery, and urology) during academic year 2020 to 2021.

Intersectional Disparities in Emergency Medicine Residents' Performance Assessments by Race, Ethnicity, and Sex.

Importance: Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments.

Objective: To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments.

Gender Bias and Ophthalmology Accreditation Council for Graduate Medical Education Milestones Evaluations.

Importance: Women remain underrepresented in ophthalmology and gender-based disparities exist in salary, grant receipt, publication rates, and surgical volume throughout training and in practice. Although studies in emergency medicine and general surgery showed mixed findings regarding gender differences in Accreditation Council for Graduate Medical Education (ACGME) Milestones ratings, limited data exist examining such differences within ophthalmology.

Objective: To examine gender differences in ophthalmology ACGME Milestones.

Competency-based medical education: The spark to ignite healthcare's escape fire.

High-value care is what patients deserve and what healthcare professionals should deliver. However, it is not what happens much of the time. Quality improvement master Dr.

The Association of ACGME Milestones With Performance on American Board of Surgery Assessments: A National Investigation of Surgical Trainees.

Objective: To determine the relationship between, and predictive utility of, milestone ratings and subsequent American Board of Surgery (ABS) vascular surgery in-training examination (VSITE), vascular qualifying examination (VQE), and vascular certifying examination (VCE) performance in a national cohort of vascular surgery trainees.

Background: Specialty board certification is an important indicator of physician competence. However, predicting future board certification examination performance during training continues to be challenging.