Competency-Based Developmental Milestones: Internal Medicine

Revised: September 1, 2016

In a joint initiative, the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Internal Medicine have released 142 Curricular Milestones to form and define the competency-based progression foundation of Internal Medicine Residency Training. Each of these curricular milestones denotes a significant point in development and helps to define the appropriate developmental trajectory of a trainee. Milestones identify and support the evaluation of the discrete knowledge, skills, and attitudes expected of trainees as they progress through Residency. A listing of these Competency Based Milestones including an approximate timeframe that trainees should meet each milestone is available in the Complete Milestones with Identifiers (PDF).

In a further evolution of the utilization of these milestones, The ACGME and ABIM have released 22 Reporting Milestones for programs to use when reviewing resident performance and reporting to ACGME. These reporting milestones will assist the program in assessing, and reporting resident overall progression in specific knowledge, skills, attitudes, and other attributes for each of the ACGME competencies that describe the development of competence from an early learner up to and beyond that expected for unsupervised practice.

These 22 Reporting Milestones will be utilized in the documentation of resident progress through training, regular reporting of this progress to the ACGME, and the culmination of resident semi-annual and final summative reviews. These 22 Reporting Milestones include observations as to how a resident:

  • Gathers and synthesizes essential and accurate information to define each patient’s clinical problems
  • Develops and achieves a comprehensive management plan for each patient
  • Manages patients with progressive responsibility and independence
  • Demonstrates skill in performing procedures.
  • Requests and provides consultative care
  • Demonstrates clinical knowledge
  • Demonstrates knowledge of diagnostic testing and procedures
  • Works effectively within an inter-professional team (e.g. peers, consultants, nursing, ancillary professionals and other support personnel)
  • Recognizes system error and advocates for system improvement
  • Identifies forces that impact the cost of healthcare and advocates for, and practices cost-effective care
  • Transitions patients effectively within and across health delivery systems
  • Monitors practice with a goal for improvement
  • Learns and improves via performance audit
  • Learns and improves via feedback
  • Learns and improves at the point of care
  • Has professional and respectful interactions with patients, caregivers and members of the inter-professional team (e.g. peers, consultants, nursing, ancillary professionals and support personnel)
  • Accepts responsibility and follows through on tasks
  • Responds to each patient’s unique characteristics and needs
  • Exhibits integrity and ethical behavior in professional conduct
  • Communicates effectively with patients and caregivers
  • Communicates effectively in inter-professional teams (e.g. peers, consultants, nursing, ancillary professionals and other support personnel)
  • Demonstrates appropriate utilization and completion of health records