Milestones Essential component of NAS are the MILESTONES

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Milestones § Essential component of NAS are the MILESTONES § Basis is to track

Milestones § Essential component of NAS are the MILESTONES § Basis is to track development in the 6 competencies § Dreyfus Model: - Novice Advanced beginner Competent Proficient Expert Master

Milestones Developed By § RRC § Boards § P. D. ’s § Residents

Milestones Developed By § RRC § Boards § P. D. ’s § Residents

Milestones Will Supplement, Not Replace Existing Assessment Tools Timeline: Develop by December 2012 Submission

Milestones Will Supplement, Not Replace Existing Assessment Tools Timeline: Develop by December 2012 Submission to ACGME 2013 & 2014

Could you present your experience with the Milestones?

Could you present your experience with the Milestones?

The Orthopaedic Surgery Milestones I. Martin Levy, MD Program Director Professor of Clinical Orthopaedic

The Orthopaedic Surgery Milestones I. Martin Levy, MD Program Director Professor of Clinical Orthopaedic Surgery

The Milestones are Coming Here

The Milestones are Coming Here

The only thing we have to fear is FEAR ITSELF …and spiders …and maybe

The only thing we have to fear is FEAR ITSELF …and spiders …and maybe the milestones

So we gathered our Chiefs of Service.

So we gathered our Chiefs of Service.

Like everyone else, we took our toolbox and started to figure out ways to

Like everyone else, we took our toolbox and started to figure out ways to recognize a competent resident.

We developed goals and objectives for each service.

We developed goals and objectives for each service.

This was not the easy part. But we ended up with a handbook.

This was not the easy part. But we ended up with a handbook.

While doing our G&O’s, we started playing with technical milestones. We called them Index

While doing our G&O’s, we started playing with technical milestones. We called them Index Procedures. We began using these Index Procedures as a way to assess achievement of independence.

I brought these IP’s to CORD’s Technical Competency Committee. During these discussions I became

I brought these IP’s to CORD’s Technical Competency Committee. During these discussions I became aware of the ACGME Milestone Project.

“A good plan violently executed now, is better than a perfect plan executed next

“A good plan violently executed now, is better than a perfect plan executed next week. ” George S. Patton Jr.

While not ecstatic over the knowledge that index procedures were going to morph into

While not ecstatic over the knowledge that index procedures were going to morph into the more complex milestones, COS familiarity with IP’s and G&O’s made the transition less painful…for me.

Dr. Nasca wrote his article, NAS became a household word and the Milestone Project

Dr. Nasca wrote his article, NAS became a household word and the Milestone Project arrived at our doorstep.

We were fortunate that the Orthopaedic Knowledge Base and Patient Care milestones were prescriptive

We were fortunate that the Orthopaedic Knowledge Base and Patient Care milestones were prescriptive and organized by subspecialty.

Each Chief of Service was asked to review their service specific milestones and discuss

Each Chief of Service was asked to review their service specific milestones and discuss feasibility.

They have successfully created a curriculum that supports the knowledge base and develops the

They have successfully created a curriculum that supports the knowledge base and develops the required surgical techniques and clinical skills.

Each resident on a service • Gets a real time review • For applicable

Each resident on a service • Gets a real time review • For applicable Milestones only • And these are uploaded

Clinical Competency Committee (C. C. C. ) Include Function § Core faculty § Evaluate

Clinical Competency Committee (C. C. C. ) Include Function § Core faculty § Evaluate milestones & early warning § Program director § Chief resident § Track progress of residents § Faculty development Purpose § Reduce potential bias § Performance measure Function § Decision making by multiple people § Evaluate 360° assessments

So we identified our Clinical Competency Committee.

So we identified our Clinical Competency Committee.

The C. C. C. was thrilled.

The C. C. C. was thrilled.

From the C. C. C. each resident receives: • Summative evaluation • Twice a

From the C. C. C. each resident receives: • Summative evaluation • Twice a year • And these are uploaded

At this early stage, and with what is at stake, I believe the only

At this early stage, and with what is at stake, I believe the only way to insure reliable input, is by meeting regularly with my Chiefs of Service.

Thank you

Thank you