Neurosurgery Resident Brigham and Women's Hospital
Introduction: The ACGME Neurosurgery Milestones were implemented to advance competency-based training in neurosurgery; however, research on milestones in neurosurgery has been more limited, and there has been no comprehensive study on the milestone ratings and the comparability of Milestones 1.0 and 2.0. The goal of this study was to describe the levels and trends of competency ratings across Milestones 1.0 and 2.0 for neurosurgical residents in the United States over the decade of implementation. Milestones 1.0 and 2.0 cover both non-technical competencies and critical technical skills.
Methods: We conducted a retrospective analysis of milestone assessments from 2013 to 2023 across 124 U.S. neurosurgery residency programs, encompassing both Milestones 1.0 (2013-2018) and Milestones 2.0 (2018-2023). We used descriptive statistics to examine the distributions of milestone ratings and identify performance trends in milestone ratings across PGY levels.
Results: The highest average rating across any milestone and all PGY levels in Milestones 1.0 was Professionalism (mean = 3.17, SD 1.02) while the average resident rating for Patient Care was the lowest (mean = 2.89, SD= 1.03). However, a shift occurred for Milestones 2.0 where Interpersonal and Communication Skills became the highest for early PGY levels and Medical Knowledge for senior residents. Patient Care remained the lowest scoring competency under both systems. Sub-competencies such as Critical Care and Brain Tumor management consistently showed high scores, while areas like Surgical Treatment of Epilepsy, Pain and Peripheral Nerves, and Pediatric Neurosurgery demonstrated lower scores.
Conclusion : A balance between non-technical competencies and critical technical skills is necessary to ensure comprehensive neurosurgical training. Established benchmarks can enhance the utility of milestone data and support the development of well-rounded, competent neurosurgeons.
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.jpg "Marcelle Altshuler, MD photo")