ACGME Milestones Data Predict Vascular Surgery Trainees’ Achievement Of Competency Targets In Professionalism And Communication
Abigail Luman, Bachelor of Science.
University of Utah School of Medicine, Salt Lake City, UT, USA.
Objectives: Surgeons’ professionalism and communication skills have a direct impact on patient care. The Accreditation Council on Graduate Medical Education (ACGME) collects Milestones data on professionalism and communication competencies for all vascular surgery trainees. It is unclear whether semiannual competency ratings predict levels of professionalism and communication at completion of training.
Methods: Comprehensive ACGME Milestone data was utilized for analysis. All trainees completing a 2-year vascular surgery fellowship (VSF) in June 2018 (n=122) and a 5-year integrated vascular surgery residency (IVSR) in June 2019 (n=52) were included. A Generalized Estimating Equations model was used to obtain predictive probability values (PPV) for the Professionalism (PROF) and Interpersonal & Communication Skills (ICS) sub-competencies, to estimate the probability of VSFs and IVSRs not reaching the recommended graduation targets based on their previous Milestones ratings.
Results: Rates of non-achievement of the recommended competency target of 4.0 by the time of graduation for PROF and ICS ranged from 8.2-24.6% for VSF and 7.7-19.2% for IVSR trainees. (Table 1) Milestones assessment ratings were predictive of achievement of competence for PROF and ICS at all time-points of biannual reporting for VSFs and most time points for IVSRs. When VSFs were rated at < 2.5 with 1 year remaining in their training program, the risk of not achieving competency ranged from 33.3% - 77.9%, with the highest risk for PROF01 – Integrity (77.9%) and ICS02 – Communication with the Healthcare Team (52.1%). Conclusions: Nearly 1 in 4 vascular surgery trainees do not achieve the ACGME Vascular Surgery Milestones targets in PROF and ICS by graduation. Biannual ACGME Milestones assessment ratings of PROF and ICS are predictive of ultimate achievement at graduation, with increasing predictive value throughout training. Early recognition of competency deficiencies in PROF and ICS will enable programs to provide feedback and remediation in these essential non-technical skills.
Table 1. Definitions of the sub-competencies and distribution of VSFs and IVSRs not reaching Level 4.0
| Sub-competency | Definition | Frequency (%) of VSFs not reaching Level 4.0 | Frequency (%) of IVSRs not reaching Level 4.0 | p-value |
| PROF01 | Integrity | 19/122 (15.6%) | 7/52 (13.5%) | 0.822 |
| PROF02 | Personal Wellbeing | 17/122 (13.9%) | 7/52 (13.5%) | 0.999 |
| PROF03 | Administrative Tasks | 30/122 (24.6%) | 10/52 (19.2%) | 0.699 |
| ICS01 | Communication with Patients and Families | 10/122 (8.2%) | 4/52 (7.7%) | 0.999 |
| ICS02 | Communication with Healthcare Team | 18/122 (14.8%) | 7/52 (13.5%) | 0.999 |
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