Forging a connection? a single-institution exploratory analysis of undergraduate medical education competency committee determinations and residency milestones

Purpose Although differing undergraduate medical education (UME) and graduate medical education (GME) assessment frameworks contribute to transition discontinuity, incorporating Accreditation Council for Graduate Medical Education (ACGME) postgraduate year 1 (PGY-1) milestone data into UME program evaluation may improve continuity. This analysis examined whether UME clinical competency committee (CCC) ratings are associated with PGY-1 milestone performance across specialties within a single institution that uses CCC procedures to support decision-making toward continuous assessment system improvement. Method This retrospective quality improvement initiative collected and analyzed data from Northwestern University Feinberg School of Medicine students in the 2022 and 2023 graduating classes in fall 2024. UME assessment domains were mapped to milestones by specialty, creating PGY-1 milestone ratings aligned with entrustable professional activities (EPAs). Ratings for 2 competencies and 6 EPAs were compared with EPA-aligned milestone ratings and mean learner ratings by ACGME competency domain using mixed-effects regression analyses. Associations were analyzed for all specialties, medical specialties only, and surgical specialties only. Results A total of 232 graduates across 18 specialties were included. Regression analyses indicated that the UME EPA 6 (oral presentation) rating was most significantly associated with mean competency ratings across multiple GME domains, including patient care (β = 0.52, P < .001), systems-based practice (β = 0.37, P < .001), and professionalism (β = 0.45, P < .001), and was significantly associated with medical specialties’ mean competency ratings, including patient care (β = 0.66, P < .001), medical knowledge (β = 0.44, P = .01), and systems-based practice (β = 0.45, P = .01). No associations were found for professionalism or communication skills. Conclusions The numerous associations between UME CCC ratings and GME end-of-PGY-1 milestone data, particularly those for medical specialties, indicate that introduction of competency-based processes within UME and harmonization of milestones within GME are lessening the continuity gap.