Appl Clin Inform 2016; 07(01): 177-190
DOI: 10.4338/ACI-2015-10-SOA-0141
State of the Art / Best Practice Paper
Schattauer GmbH

Milestones: Critical Elements in Clinical Informatics Fellowship Programs

Howard Silverman
1  The University of Arizona College of Medicine - Phoenix
Christoph U. Lehmann
2  Vanderbilt University, Nashville, TN
Benson Munger
1  The University of Arizona College of Medicine - Phoenix
› Author Affiliations
Further Information

Publication History

received: 21 October 2015

accepted: 15 January 2016

Publication Date:
16 December 2017 (online)



Milestones refer to points along a continuum of a competency from novice to expert. Resident and fellow assessment and program evaluation processes adopted by the ACGME include the mandate that programs report the educational progress of residents and fellows twice annually utilizing Milestones developed by a specialty specific ACGME working group of experts. Milestones in clinical training programs are largely unmapped to specific assessment tools. Residents and fellows are mainly assessed using locally derived assessment instruments. These assessments are then reviewed by the Clinical Competency Committee which assigns and reports trainee ratings using the specialty specific reporting Milestones.

Methods and Results

The challenge and opportunity facing the nascent specialty of Clinical Informatics is how to optimally utilize this framework across a growing number of accredited fellowships. The authors review how a mapped milestone framework, in which each required sub-competency is mapped to a single milestone assessment grid, can enable the use of milestones for multiple uses including individualized learning plans, fellow assessments, and program evaluation. Furthermore, such a mapped strategy will foster the ability to compare fellow progress within and between Clinical Informatics Fellowships in a structured and reliable fashion. Clinical Informatics currently has far less variability across programs and thus could easily utilize a more tightly defined set of milestones with a clear mapping to sub-competencies. This approach would enable greater standardization of assessment instruments and processes across programs while allowing for variability in how those sub-competencies are taught.


A mapped strategy for Milestones offers significant advantages for Clinical Informatics programs.