More recently, the ACGME has developed a new accreditation system, which focuses on specialty-specific competencies called milestones. In 2001, the ACGME convened groups of leaders from the educational community in each specialty, called the Quadrads (4), to develop descriptions of specialty-specific competencies in each specialty of medicine. The Quadrad committees were composed of individuals representing the American Board of Medical Specialties (ABMS) Member Board, the Program Directors’ Association (where applicable), the RRC, and a resident representative. The Milestone project has incorporated similar representation from stakeholder groups (now also including the specialty academies, colleges, and societies), that have articulated educational milestones that residents should achieve throughout their education and for which individual trainees should be rated as “proficient.” The general model of competency development includes five levels: Level 1: expectations for beginning residents; Level 2: expectations for residents who have advanced over entry but are performing at a lower level than expected at mid-residency; Level 3: expectations for developmental milestones expected at mid-residency; Level 4: expectations for the knowledge, skills, and attitudes residents should have at the completion of training; and Level 5: expectations for milestones that exceed expectations at the completion of training. Also, the Milestone groups have been working closely with the ACGME Assessment Committee to produce comprehensive specialty-specific evaluation tools to be used as part of this process. These assessments take many forms, including peer evaluations, in-service examinations, direct observation, and simulation, among others.
By increasing the emphasis on performance capabilities, the Milestone Project should help to expand the outcome and evidence-base for accreditation and certification and enhance public accountability. The milestones have been designed to be feasible (a manageable number) as well as meaningful, substantive, and measurable. Also, the ACGME is developing standardized reporting to create a central data repository for milestone performance. In this new system, the attainment of milestones by residents will be one of the metrics by which programs are evaluated and accredited going forward. Evaluation of these metrics and standards will make it possible for the ACGME to provide extended accreditation for programs with satisfactory metrics and limit more frequent in-person site visits to programs in difficulty. Draft milestones in Psychiatry will be posted for public comment and piloted before their formal use as part of the accreditation process.