Milestones Evaluation System

Have you ever received an evaluation, whether good or bad, and didn't feel you got much out of it? Could there be another way?

Several years ago, the ACGME announced plans to use milestone evaluation as part of the next accreditation system.

Our residency was one of the first in the country to create a complete evaluation system using these concepts, and we now have one of the most advanced integrated systems of its kind in the country. 

We have published our initial experiences using this system after collecting more than 1.5 million data points:

• Entrustment and Mapping
• Entrusting Observable Practice Activities
• Critical Deficiency Ratings
• Transforming Resident Assessment
• Narratives Predict Performance
• Assessing Non Cognitive Skills
• Developing the Expected Score

First, we rewrote the entire curriculum for every rotation using Observable Practice Activities (OPAs) as basic unit. OPAs are skills you should be able to do after any given rotation. Content OPAs are skills that differ for each rotation depending on the type of medicine learned (approximately 7 per rotation). Process OPAs are skills, such as communication skills, that are conserved across rotations (approximately 10 per rotation).

This means that every rotation has a different set of skills you must learn, and a different evaluation to make sure you master these skills. To view the entire curriculum along with a listing of these skills, download the following:

UC IM Residency Curriculum 2024-2025

Our rating scale for each OPA (skill) is based on a 5 point entrustment score:

1. you cannot do the skill (critical deficiencies)
2. you can do the skill with ongoing proactive supervision
3. you can do the skill with distance supervision
4. you can do the skill independently
5. you can teach the skill

Your rotation evaluation consists of attending assessment of the skills, plus multisource evaluation OPAs from peers and allied health professionals.

To see how we use this assessment system to help residents achieve the competence needed for graduation, watch this brief video:

Observable Practice Activities Assessment System.

To see a set of videos used during educational workshops regarding non-MD assessment of resident skills, click on the links below:

The Value of Non Physician Observations in Resident Assessment: Inpatient Case

The Value of Non Physician Observations in Resident Assessment: Outpatient Case