Milestones, EPAs, and NAS

Next Accreditation System

AAIM is gathering tools and resources to assist faculty with the implementation of the Next Accreditation System (NAS). The topics below features forms shared by your colleagues. Forms are available only in the original format provided.

Q Sort and 5-Step Assessment Tools

These blank templates from Southern Illinois University (SIU) can be used to facilitate a Q sort for establishing priorities and reaching consensus around the candidate curricular milestones that best inform a particular EPA.

• Q-Sort Group Tally Sheet (MS Excel)
• Q-Sort Individual Sheet (MS Excel)
• Q-Sort Ranking System (MS PowerPoint)
• Q-Sort Scoring Sheet (MS Excel)

Also, the following are five steps to create an end of rotation Curricular Milestone assessment tool. This tool was modified from an original created by SIU before the publication of the curricular milestones.

• Steps to Design a Curricular Milestone based End of Rotation Assessment (Southern Illinois University School of Medicine)

Resident Evaluation Forms Using RIME Score 1 to 4

Using these forms, a resident evaluation committee can decide on three questions for each of the Core Competency measures. These questions are chosen to generate the appropriate level of progress for the respective year of training. The questions are answered by direct observation, discussion during rounds, during video or simulation labs, or 1:1 mentor resident interactions, and given a RIME score 1-4.

• Residency Evaluation Form – Template (Mercy Hospital & Medical Center)
• Example of Residency Evaluation Form – History and Physical Exam (Mercy Hospital & Medical Center)
• Patient Care Progressive Responsibilities (Mercy Hospital & Medical Center)

PGY Level-Specific Self-Assessment Forms

Program directors can use milestones based self-evaluation forms for their residents prior to semi-annual meetings. Moreover, these forms can assist program directors in determining which milestones are most important to the programs.

Example self-assessment forms have been developed by APDIM members:

• R1 Self-assessment evaluation form (Lankenau Medical Center)
• R2 Self-assessment evaluation form (Lankenau Medical Center)
• R3 Self-assessment evaluation form (Lankenau Medical Center)

Milestone-based Evaluation Form

• Milestone-based Evaluation (University of Minnesota Medical School)
• Cross-Rotation Evaluation Form (PDF) (University of New Mexico School of Medicine)
• Milestone-Based Evaluation (Greater Baltimore Medical Center)

As part of the 2013 APDIM Spring Education Precourse, participants each completed a q-sort exercise by linking milestones to end-of-training entrustable professional activities (EPAs).

For the purposes of this activity, the AAIM Education Redesign Committee assigned 22 specific curricular milestones for each EPA. The game board, printing template, and templates for milestones playing cards can be downloaded for faculty use.

Templates for Milestones Playing Cards (Labeled by EPA):

• EPA 1 - Manage care of patients with acute common diseases across multiple care settings
• EPA 2 - Manage care of patients with acute complex diseases across multiple care settings
• EPA 3 - Manage care of patients with chronic diseases across multiple care settings
• EPA 4 - Provide age-appropriate screening and preventative care
• EPA 5 - Resuscitate, stabilize, and care for unstable or critically ill patients
• EPA 6 - Provide perioperative assessment and care
• EPA 7 - Provide general internal medicine consultation to non-medical specialties
• EPA 8 - Manage transitions of care
• EPA 9 - Facilitate family meetings
• EPA 10 - Lead and work within interprofessional health care teams
• EPA 11 - Facilitate the learning of patients, families, and members of the interdisciplinary team
• EPA 12 - Enhance patient safety
• EPA 13 - Improve the quality of health care at both the individual and systems level
• EPA 14 - Advocate for individual patients
• EPA 15 - Demonstrate personal habits of lifelong learning
• EPA 16 - Demonstrate professional behavior

Tools for Creating Q-Sort Exercise:

• Download Q-Sort game board
• Download blank template for Q-Sort pieces
• Download instructions (with pictures) for printing Q-Sort playing cards
• Download printable sheet for all 142 curricular milestones

Instructions for Creating Q-Sort Playing Cards Using Post-it Notes:

1. Print the blank template on a standard sheet of paper
2. Place blank post-it notes onto each square of the template (notes must be placed in the same direction)
3. Feed the template with Post-it notes into printer (make sure side with adhesives is fed first)
4. Print document with assigned 22 milestones (labeled by EPA) onto the sheet with Post-it notes created in step 2

The template sheets are designed for 1-1/2 x 2 Post-it notes.

"Resident Assessment Using EPAs: Helping Program Directors Design Evaluation Systems to Meet Reporting Requirements for the ACGME Next Accreditation System (NAS)"

A video of the precourse is posted on the APDIM Forum for Milestones Innovation and Collaboration on AAIM Connect. This community is open only to AAIM members. Note that the file is very large and make take several minutes to download.

• View precourse video
• View presentation materials from the precourse

• Tools & Resources
• Core Competency Milestones
• End of Training EPAs
• NAS Resources
• Subspecialty Fellowship Milestones

Wright-Patterson Medical Center has compiled evaluation forms for Ambulatory Medicine, Consultation Medicine, Inpatient Medicine and Night Float distributed among R1, R2, and R3.

Ambulatory Medicine

• R1 Evaluation Form
• R2 Evaluation Form
• R3 Evaluation Form

Consultation Medicine

• R1 Evaluation Form
• R2 Evaluation Form
• R3 Evaluation Form

Inpatient Medicine

• R1 Evaluation Form
• R2 Evaluation Form
• R3 Evaluation Form

Night Float

• R1 Evaluation Form
• R2 Evaluation Form
• R3 Evaluation Form