Transition between Residency and Fellowship

OBJECTIVE: To understand residency to fellowship transition by exploring the alignment of graduating general surgery (GS) residency and early vascular surgery fellowship (VSF) ACGME Milestones 2.0 competencies. BACKGROUND: Milestones 2.0 presents an opportunity to evaluate trainee progression from residency through fellowship. Understanding the residency-fellowship alignment of Milestones ratings is important for the training continuum and identifying early signals for struggling learners during this transition. METHODS: This is a retrospective national study of two VSF cohorts (starting 2022 and 2023) who previously completed GS residency. We compared ACGME Milestones 2.0 ratings from the final 2 years of residency to year-1 VSF using descriptive statistics and linear mixed effects regression models. RESULTS: Milestones data were collected for vascular surgery fellows (n=266). Results showed significant PGY-5 GS-VSF predictive alignment for PC (β=0.20, P=0.004); MK (β=0.13, P=0.027); PROF (β=0.23, P<0.001); and ICS (β=0.17, P=0.01). These results translate to a mean fellowship Milestones level difference between learners up to 0.49 to 0.64 units for every 1-unit difference in Milestones between GS residents. SBP and PBLI ratings were not significantly aligned. Matched subcompetencies showed significant alignment (3 of 4 PC, 2 of 2 MK, 4 of 4 PROF, 2 of 3 ICS). CONCLUSIONS: The alignment between graduating GS residents and VSF year-1 Milestones ratings for PC, MK, PROF, and ICS demonstrates a continuum in educational outcomes and potential use to facilitate the residency-fellowship transition. These findings may support using Milestones 2.0 for residency-fellowship hand-off and performance analytics that may serve as early feedback to support trainees.