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

Correspondence to:

Howard Silverman, MD MS
The University of Arizona College of Medicine - Phoenix
435 North 5th Street
Phoenix, Arizona 85004
USA

Publication History

received: 21 October 2015

accepted: 15 January 2016

Publication Date:
16 December 2017 (online)

 

Summary

Background

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.

Conclusions

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


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Conflicts of Interest

The authors declare that they have no conflicts of interest in the research.

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Correspondence to:

Howard Silverman, MD MS
The University of Arizona College of Medicine - Phoenix
435 North 5th Street
Phoenix, Arizona 85004
USA

  • References

  • 1 Cantrell RW, Goldstein JC. The American Board of Otolaryngology, 1924–1999: 75 years of excellence. Arch Otolaryngol Head Neck Surg 1999; 125 (10) 1071-1079.
  • 2 Livingood CS. History of the American Board of Dermatology, Inc (1932–1982). J Am Acad Dermatol 1982; 07 (06) 821-850.
  • 3 Cordes FC, Rucker CW. History of the American Board of Ophthalmology. Trans Am Ophthalmol Soc 1961; 59: 295-332.
  • 4 Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system--rationale and benefits. N Engl J Med 2012; 366 (11) 1051-1056.
  • 5 Sklar DP. Competencies, milestones, and entrustable professional activities: what they are, what they could be. Acad Med 2015; 90 (04) 395-397.
  • 6 ACGME Program Requirements for Graduate Medical Education in Clinical Informatics. (Review Committees for Anesthesiology, Diagnostic Radiology, Emergency Medicine, Family Medicine, Internal Medicine, Medical Genetics and Genomics, Pathology, Pediatrics, or Preventive Medicine) [Internet]. Chicago: IL: Accreditation Council for Graduate Medical Education; 7/1/2015 [updated 2/3/2014; cited 12/12/2015]. Available from: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequire ments/381_clinical_informatics_07012015.pdf
  • 7 Frequently Asked Questions: Milestones [Internet]. Chicago: IL: Accreditation Council for Graduate Medical Education (ACGME); [updated 9/2015; cited 12/12/2015]. Available from: https://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf
  • 8 Lehmann CU, Shorte V, Gundlapalli AV. Clinical informatics sub-specialty board certification. Pediatr Rev 2013; 34 (11) 525-530.
  • 9 Safran C, Shabot MM, Munger BS, Holmes JH, Steen EB, Lumpkin JR. et al. Program requirements for fellowship education in the subspecialty of clinical informatics. J Am Med Inform Assoc 2009; 16 (02) 158-166 Erratum in: J Am Med Inform Assoc 2009; 16(4): 605. PubMed PMID: 19074295; PubMed Central PMCID: PMC2649323.
  • 10 The Clinical Informatics Milestone Project. [Internet]. Chicago: IL: A Joint initiative of The Accreditation Council for Graduate Medical Education; The American Board of Anesthesiology; The American Board of Emergency Medicine; The American Board of Family Medicine; The American Board of Genetics and Genomics; The American; 10/2014 [cited 12/12/2015]. Available from: https://www.acgme.org/acgme web/Portals/0/PDFs/Milestones/ClinicalInformatics.pdf
  • 11 Gardner RM, Overhage JM, Steen EB, Munger BS, Holmes JH, Williamson JJ. et al. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc 2009; 16 (02) 153-157.