Essential component of NAS are the MILESTONES

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Milestones

• Essential component of NAS are the MILESTONES
• Basis is to track development in the 6
  competencies
• Dreyfus Model
• Novice
• Advanced beginner
• Competent
• Proficient
• Expert
• Master

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Milestones
Milestones Developed By

• RRC
• Boards
• P.D.s
• Residents

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Milestones
Milestones Will Supplement, Not Replace Existing
Assessment Tools

• Develop by December 2012
• Submission to ACGME 2013 2014

Timeline
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Could you present your experience with the
Milestones?
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The Orthopaedic Surgery Milestones
I. Martin Levy, MD Program Director Professor of
Clinical Orthopaedic Surgery
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The Milestones are ComingHere
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The only thing we have to fear is FEAR
ITSELFand spidersand maybe the milestones
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So we gathered our Chiefs of Service.
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Like everyone else, we took our toolbox and
started to figure out ways to recognize a
competent resident.
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We developed goals and objectives for each
service.
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This was not the easy part.
But we ended up with a handbook.
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While doing our GOs, we started playing with
technical milestones. We called them Index
Procedures. We began using these Index
Procedures as a way to assess achievement of
independence.
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I brought these IPs to CORDs Technical
Competency Committee. During these discussions I
became aware of the ACGME Milestone Project.
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A good plan violently executed now,is better
than a perfect plan executed next week.
George S. Patton Jr.
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While not ecstatic over the knowledge that index
procedures were going to morph into the more
complex milestones, COS familiarity with IPs and
GOs made the transition less painfulfor me.
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Dr. Nasca wrote his article, NAS became a
household word and the the Milestone Project
arrived at our doorstep.
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We were fortunate that the Orthopaedic Knowledge
Base and Patient Care milestones were
prescriptive and organized by subspecialty.
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Each Chief of Service was asked to review their
service specific milestones and discuss
feasibility.
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They have successfully created a curriculum that
supports the knowledge base and develops the
required surgical techniques and clinical skills.
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Each resident on a service

• Gets a real time review
• For applicable Milestones only
• And these are uploaded

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Clinical Competency Committee (C.C.C.)
Include
Function
Purpose

• Core faculty
• Program director-
• Chief resident

• Evaluate milestones early warning
• Track progress of residents
• Faculty development

• Reduce potential bias
• Performance measure
• Decision making by multiple people
• Evaluate 360 assessments

Function
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So we identified our Clinical Competency
Committee.
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The C.C.C. was thrilled.
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From the C.C.C. each resident receives

• Summative evaluation
• Twice a year
• And these are uploaded

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At this early stage, and with what is at stake, I
believe the only way to insure reliable input, is
by meeting regularly with my Chiefs of Service.
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Thank you