UME/GME Program Resources

Milestones, EPAs, and NAS

Tools & Resources

Under the ACGME Next Accreditation System, program directors are seeking tools, templates, and information to operationalize the internal medicine milestones for the assessment of resident competence using entrustable professional activities (EPAs).

The AAIM Education Committee is charged to discuss issues about the implementation of milestones in residency and fellowship, competency-based progression in training, and member education concerning new approaches to training. Visit this page regularly to view updated materials, including templates, sample documents, competency maps, and other useful resources.

Definitions to Get You Started

Competency-Based Medical Education:
An outcomes-based approach to the design, implementation, assessment and evaluation of a medical education program using an organizing framework of competencies.

An observable ability of a health professional related to a specific activity that integrates knowledge, skills, values, and attitudes. Since they are observable, they can be measured and assessed. They can be assembled like building blocks to facilitate progressive development.

Possessing the knowledge, skills, and attitudes across multiple domains or aspects of performance in a certain context. Statements about competence require descriptive qualifiers to define the relevant abilities, context, and stage of training. Competence is multi-dimensional and dynamic, changing with time, experience, and setting.

Entrustable professional activities (EPAs):
The specific knowledge, skills and attitudes acquired over the course of training that society and our profession believe are critical to performing as a physician. EPAs are defined by milestones in each competency.

A significant point in development and helps to define the appropriate developmental trajectory of a trainee. Milestones identify the discrete knowledge, skills, and attitudes expected of learners as they progress through training.

Standardized descriptions that will be used to identify and describe residents as they move toward competence in a category or EPA. Program directors will NOT be asked to write individual narratives about each resident.

Literature Behind NAS, Milestones, and EPAs

Association of American Medical Colleges Group on Resident Affairs. ACGME Next Accreditation System. 2012. Online. Accessed April 16, 2012. Presentation

Nasca, TJ, Philibert I, Brigham T, Flynn T. The next GME accreditation system-rationale and benefits. New Engl J Med. 2012;366(11):1501-1506. Full text »

Ginsburg S, McIlroy J, Oulanova O, et al. Toward authentic clinical evaluation: Pitfalls in the pursuit of competency. Acad Med. 2010;85(5):780-786. Full text »

Green M, Aagaard E, Caverzagie K, et al. Charting the road to competence: Developmental milestones for internal medicine residency training. J Grad Med Educ. 2009;1(1):5-20. Full text »

Kennedy T, Regehr G, Baker G R, Lingard L. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008;83(10):589-592. Full text »

Ten Cate O, Scheele F. Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Acad Med. 2007;82(6):542-547. Full text »

Carraccio C, Wolfsthal S, Englander R. Shifting paradigms: From Flexner to competencies. Acad Med. 2002;77(5):361-367. Full text »