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As the ACGME began to move toward continuous accreditation, specialty groups developed outcomes-based milestones as a framework for determining resident and fellow performance within the six ACGME Core Competencies.

What are Milestones?

Simply defined, a milestone is a significant point in development. For accreditation purposes, the Milestones are competency-based developmental outcomes (e.g., knowledge, skills, attitudes, and performance) that can be demonstrated progressively by residents and fellows from the beginning of their education through graduation to the unsupervised practice of their specialties.

Who developed the Milestones?

Each specialty’s Milestone Working Group was co-convened by the ACGME and relevant American Board of Medical Specialties (ABMS) specialty board(s), and was composed of ABMS specialty board representatives, program director association members, specialty college members, ACGME Review Committee members, residents, fellows, and others.

Why Milestones?

First and foremost, the Milestones are designed to help all residencies and fellowships produce highly competent physicians to meet the health and health care needs of the public. To this end, the

Milestones serve important purposes in program accreditation:

      • Allow for continuous monitoring of programs and lengthening of site visit cycles
      • Public Accountability – report at a national level on aggregate competency outcomes by specialty
      • Community of practice for evaluation and research, with focus on continuous improvement of graduate medical education

For educational (residency/fellowship) programs, the Milestones will:

      • Provide a rich descriptive, developmental framework for clinical competency committees
      • Guide curriculum development of the residency or fellowship
      • Support better assessment practices
      • Enhance opportunities for early identification of struggling residents and fellows

And for residents and fellows, the Milestones will:

      • Provide more explicit and transparent expectations of performance
      • Support better self-directed assessment and learning
      • Facilitate better feedback for professional development

How will the Milestones be used by the ACGME?

Residents’/fellows' performance on the Milestones will become a source of specialty-specific data for the specialty Review Committees to use in assessing the quality of residency and fellowship programs and for facilitating improvements to program curricula and resident performance if and when needed. The Milestones will also be used by the ACGME to demonstrate accountability of the effectiveness of graduate medical education within ACGME-accredited programs in meeting the needs of the public.

Feedback and Questions

We welcome your feedback and encourage you to check this website periodically as we update information and provide additional resources to help programs with their Milestones implementation.

Questions regarding Milestones development should be directed to and someone from the Milestones Department will respond as soon as possible.

Milestones Staff

Eric S. Holmboe MD
Senior Vice President, Milestone Development and Evaluation

Laura Edgar EdD, CAE
Executive Director, Milestones Development

Stanley Hamstra, PhD
Vice President, Milestone Research and Evaluation

Milestones News

Feedback and Questions
Milestones Department
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Accreditation Council for Graduate Medical Education
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