The Accreditation Council for Graduate Medical Education (ACGME) requires anesthesiology training programs to submit Milestones ratings for each resident every 6 months, starting in the 2014 to 2015 academic year. We aimed to understand how anesthesiology residents progress through the Milestones evaluations from residency entry to graduation. Anesthesiology Milestones 1.0 included 25 subcompetencies in 6 core competencies of Patient Care, Medical Knowledge, Systems-Based Practice, Practice-Based Learning 28.8% to 36.8% of the graduating cohort did not reach Level 4 for at least 1 subcompetency among the 6 core competencies. One hundred and thirty-six programs (88.9% of 153) had straight-lining for at least 1 reporting period. For the multilevel linear mixed-effect models, the fixed intercept estimates were close to 1.0 for Professionalism and Interpersonal the fixed slope estimates were near 1.0 for all 25 subcompetencies. Across all subcompetencies, residency programs accounted for 63% to 84% of between-resident variability in the baseline ratings and 60% to 92% of between-resident variability in the growth rates. We found a high prevalence of straight-lining in Anesthesiology Milestones 1.0 ratings. This raises concerns about whether Milestones evaluations reflect individual resident performance in specific domains. The programs explained most of the between-resident variability in both baseline ratings and growth rates. Future studies are needed to promote standardization and consistency of Milestones evaluations, allowing learners to track their progress and target specific areas to improve performance.
Ye et al. (2025) studied this question.