Milestones, EPAs, and NAS

Subspecialty Fellowship Milestones

Internal Medicine Subspecialty Milestones Now Available

ACGME, ABIM, and AAIM have released the internal medicine subspecialty milestones for the Next Accreditation System, which goes into effect July 1 for subspecialty fellowship programs. The milestones were developed by the stakeholders—including 25 specialty societies—over a series of summits held in 2013. While the subspecialty milestones are patterned on the internal medicine milestones, key differences are the inclusion of scholarly activity components as well as aspirational and critical deficiency stages.

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Copyright (c) 2014 The Accreditation Council for Graduate Medical Education and The American Board of Internal Medicine. All rights reserved. The copyright owners grant third parties the right to use the Internal Medicine Subspecialty Milestones on a non-exclusive basis for educational purposes.

Third Internal Medicine Subspecialty Milestones Summit Brings Consensus Even Closer

To address the final areas of consensus on fellowship milestones, AAIM, ABIM, and ACGME hosted the third Internal Medicine Subspecialty Reporting Milestones Summit November 11 in Chicago, IL. The meeting brought together 25 societies and stakeholders to hear the recommendations of the workgroups formed at the second summit (May 13) about scholarly activity components and aspirational and critical deficiency stages in the milestones as well as the perspectives of multispecialty groups and cardiology. Discussions continue on merging the work of the groups and improving the language in the text. Final approved fellowship milestones are due to ACGME on December 31, 2013.

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AAIM, ABIM, and ACGME Host Second IM Subspecialty Milestones Summit

In an effort to continue the work of internal medicine subspecialty societies, AAIM, the American Board of Internal Medicine (ABIM), and the Accreditation Council for Graduate Medical Education (ACGME) hosted the second Internal Medicine Subspecialty Milestones Summit. The May 15 meeting continued the work of the first summit by addressing modifications to the internal medicine milestones. Specifically, participants met in small groups to discuss enriching scholarly activity components in the milestones as well as calibrating the aspirational and critical deficiency stages.

Going forward, representatives from the societies will develop templates for general subspecialty milestones through participation in two workgroups. These templates will then be reviewed by societal representatives to determine if further modifications to the milestones are needed.

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AAIM, ABIM, ACGME, and Subspecialty Societies Launch Subspecialty Milestones Discussions

AAIM and ABIM co-hosted a summit February 11-12 in Alexandria, VA, to bring subspecialty societies to a common understanding in regard to fellowship milestones. Representatives from ABIM, ACGME, and AAIM presented updates on their own efforts in preparation for the launch of NAS, while everyone acquired a common vocabulary and understanding through an overview of competency-based medical education. Presentations from subspecialties already immersed in milestone development and pilot projects—American Association for the Study of Liver Disease, American College of Cardiology, and the American Geriatrics Society—provided information about the collaborative process, barriers, and implementation plans as well as offered a broad range of approaches and resource utilization. Subspecialty based small group discussions helped generate commonalities in several competencies. AAIM will remain at the forefront of this work, uniting the academic internal medicine community as it prepares for NAS.

November 29, 2012 - ASP to Host Subspecialty Milestones Summit in February 2013

ASP and AAIM are collaborating with the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education to bring together societal representatives for the Internal Medicine Subspecialty Milestones Summit. To be held February 11-12, 2013, in Alexandria, VA, the goals of the summit are discuss the ACGME NAS charge and timeline for developing subspecialty milestones; provide an update on current milestone development work in internal medicine and selected subspecialties; and develop appropriate strategies to efficiently develop subspecialty milestones capitalizing on existing milestones development work.

June 1, 2012 - Clarification about Fellowship Milestones

Although the NEJM article that announced the Next Accreditation System (NAS) indicated that milestones would be one of the data elements that RRC-IM will receive annually to determine whether programs are in “good standing,” milestones for the subspecialties will not be available when the RRC-IM transitions into NAS in 2013. Milestones for all of the subspecialties will be developed and introduced at some point in the future. This will allow ACGME and ABIM (the partners in the milestones venture) to solicit the input and wisdom of the education leaders in the subspecialty communities to develop the subspecialty-specific milestones.

It seems there is still some confusion about expectations -- possibly because the fellowship program directors may be receiving a different message from their core programs. So, in order to clarify expectations, at this point in time, the development of ACGME/ABIM Milestones for subspecialties has not officially begun. When work in this area does begin (in the future), ACGME and ABIM will contact subspecialty societies and ask the leadership to recommend individuals to participate in this initiative.

More Information

Need Faculty Development Tools for Milestones?

AAIM offered seminars specifically addressed to give fellowship faculty and staff the vocabulary, skill sets, and tools to use the subspecialty milestones for evaluation

Seminar Presentations

Want to Know How the Milestones Were Developed?

A series of webinars, “Introduction to Internal Medicine Subspecialty Reporting Milestones,” provided an overview of the development process, draft version of the subspecialty milestones, and discussed ways that the milestones may be used and provided subspecialty society representatives with the opportunity to review and provide feedback. A helpful glossary of competency-based medical education terms has additionally been provided for reference with the presentation.

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