Rheumatology Milestones 2.0 offers specialty-specific 'enhanced evaluation tool' for fellows
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Rheumatology Milestones 2.0 provides a rheumatology-specific “enhanced evaluation tool” with a “learner-centered educational approach” that will be used by every rheumatology fellowship training program in the U.S., researchers noted.
Developed through a partnership between the Accreditation Council of Graduate Medical Education, the American Board of Internal Medicine and the American College of Rheumatology, Rheumatology Milestones 2.0 also offers a supplemental guide, with examples and resources illustrating how best to use these milestones.
“This study describes the needs assessment for and development of the Accreditation Council for Graduate Medical Education Rheumatology Milestones 2.0, which will be used by all U.S. rheumatology fellowship training programs once they are officially implemented in the coming year,” Jason E. Liebowitz, MD, of Skylands Medical Group, in Rockaway, N.J., told Healio Rheumatology.
“Previously, all internal medicine subspecialties utilized the same set of Reporting Milestones — Subspecialty Reporting Milestones — even though the skillset and training of a rheumatology fellow differs substantially from that of other subspecialties, such as cardiology or gastroenterology,” he added. “A needs assessment survey was conducted of over 500 internal medicine subspecialty program directors and revealed that 85% preferred subspecialty-specific milestones over the previous ‘generic’ internal medicine subspecialty milestones.”
To develop relevant specialty-specific milestones that provide a practical and universal framework for the assessment and evaluation of rheumatology fellows, the ACGME tasked the ACR and ABIM to create a Rheumatology Milestones 2.0 working group. This group included seven rheumatology program directors, two division directors, a community practice rheumatologist, a rheumatology fellow‐in‐training and a rheumatology patient/member of the public.
The ACGME Vice President for Milestones Development oversaw the group, which met over the course of three 12-hour, in-person sessions between December 2018 and October 2019. During these meetings, members composed the Rheumatology Specialty Milestones and Supplemental Guide to fall within the ACGME Milestones 2.0 Project. The group later presented its final Rheumatology Milestones evaluation tool after a 4-week public comment period.
The working group developed 21 subcompetencies as part of the updated Rheumatology Milestones. Each fellowship program’s CCC uses a 6-month reporting period to assess each fellow’s completed evaluations and designates the milestone levels that best describe each fellow’s current characteristics, performance and abilities for each subcompetency.
According to Liebowitz and colleagues, Rheumatology Milestones 2.0 “demonstrates substantial differences from the IM Subspecialty Reporting Milestones with respect to content, specificity, and supplemental information.” For example, the updated milestones provide more rheumatology-specific context to describe the expectations and attributes needed to achieve the knowledge, attitudes and skills for independent practice; this means there is a better chance that assessments will be distributed more widely across levels, they wrote.
In addition, Rheumatology Milestones 2.0 removes the “critical deficiency” descriptor at Level 1. According to the working group, fellows are not often identified as having critical deficiencies, though may clearly benefit from further skill set development. Rather, the updated milestones use the term “novice” as a positive descriptor, with specific metrics outlined to help the fellow progress.
“Our article provides transparency regarding the theory and process behind the development of the Rheumatology Milestones 2.0,” Liebowitz said. “These Milestones are introduced to the general rheumatology community, which includes fellows-in-training, academic rheumatologists, and rheumatologists in community practice. We hope the rheumatology community will find this manuscript to be informative, recognizing the gaps identified by the needs assessment, and finding value in rheumatology-specific milestones, as through this project we seek to enrich the training environment for our fellows who are soon to be new entrants into rheumatology practice.”
Perspective
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David A. McLain, MD, FACP, FACR
The first ABIM board examination for rheumatology was administered in 1971. This was an oral exam and a fellow practicing rheumatologist, Bryan Dewees, recalled to me that he took the first board exam with Gene Ball and Claude Bennett. Claude Bennett was later a president of the American College of Rheumatology and president of University of Alabama at Birmingham.
Rheumatology as a specialty traces its roots in this country to an interest group that met in 1928 and was named the American Committee for the Control of Rheumatism (ACCR). In 1937, the group was renamed the American Rheumatism Association (ARA). The first American rheumatology journal was published in 1958, lagging 25 years behind the European journals. Between 1919 and 1937, 6 rheumatology units were established in the US.
One of the first units was at the Mayo Clinic, headed by Dr. Philip Hench, who went on the received the Nobel Prize in Medicine with his colleague, Edward Kendall, for the discovery of cortisone in 1950. In the early 1960s, 10% of ARA members had trained under Dr. Hench. Other early rheumatology units were at Harvard- Massachusetts General Hospital, Presbyterian-Columbia, NYU, University of Pennsylvania and the Cleveland Clinic. From 75 members in 1934, the ACR has grown to over 8,000 members. This article introduces another level of sophistication in the progression of rheumatology as a specialty.
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