Emergency Medicine Milestones Final Ratings Are Often Subpar

Background:The emergency medicine (EM) milestones are objective behaviors that are categorizedinto thematic domains called"subcompetencies"(eg, emergency stabilization). The scale for ratingmilestones is predicated on the assumption that a rating (level) of 1.0 corresponds to an incoming EM-1resident and a rating of 4.0 is the"target rating"(albeit not an expectation) for a graduating resident. Ouraim in this study was to determine the frequency with which graduating residents received the targetmilestone ratings.Methods:This retrospective, cross-sectional study was a secondary analysis of a dataset used in a priorstudy but was not reported previously. We analyzed milestone subcompetency ratings from April25-June 24, 2022 for categorical EM residents in theirfinal year of training. Ratings were dichotomizedas meeting the expected level at the time of program completion (ratings of >= 3.5) and not meeting theexpected level at the time of program completion (ratings of <= 3.0). We calculated the number of residentswho did not achieve target ratings for each of the subcompetencies.Results:In Spring 2022, of the 2,637 residents in the spring of their last year of training, 1,613 (61.2%)achieved a rating of >= 3.5 on every subcompetency and 1,024 (38.8%) failed to achieve that rating on atleast one subcompetency. There were 250 residents (9.5%) who failed to achieve half of their expectedsubcompetency ratings and 105 (4.0%) who failed to achieve the expected rating (ie, rating was <= 3.0) onevery subcompetency.Conclusion:When using an EM milestone rating threshold of 3.5, only61.2% of physicians achievedthetarget ratings for program graduation; 4.0% of physicians failed to achieve target ratings for anymilestone subcompetency; and 9.5% of physicians failed to achieve the target ratings for graduatingresidents in half of the subcompetencies