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Entrustable Professional Activities and Curricular Milestones for Fellowship Training in Pulmonary and Critical Care MedicineMilestones and Entrustable Professional Activities: Report of a Multisociety Working Group FREE TO VIEW

Henry E. Fessler, MD, FCCP; Doreen Addrizzo-Harris, MD, FCCP; James M. Beck, MD; John D. Buckley, MD; Stephen M. Pastores, MD, FCCP; Craig A. Piquette, MD, FCCP; James A. Rowley, MD; Antoinette Spevetz, MD, FCCP
Author and Funding Information

From Johns Hopkins University School of Medicine (Dr Fessler), Baltimore, MD; New York University School of Medicine (Dr Addrizzo-Harris), New York, NY; Memorial Sloan-Kettering Cancer Center (Dr Pastores), Weill Cornell Medical College, New York, NY; University of Colorado School of Medicine (Dr Beck) and Veterans Affairs Eastern Colorado Health Care System (Dr Beck), Denver, CO; Indiana University School of Medicine (Dr Buckley), Indianapolis, IN; University of Nebraska Medical Center (Dr Piquette) Omaha, NE; Wayne State University School of Medicine (Dr Rowley), Detroit, MI; and Cooper Medical School of Rowan University (Dr Spevetz), Camden, NJ.

CORRESPONDENCE TO: Henry E. Fessler MD, FCCP, Pulmonary and Critical Care Medicine, 1830 E Monument St, 5th floor, Baltimore, MD 21205; e-mail: hfessler@jhmi.edu


*Dr Addrizzo-Harris and Dr Buckley for the American College of Chest Physicians; Dr Beck and Dr Rowley for the American Thoracic Society; Dr Pastores and Dr Spevetz for the Society of Critical Care Medicine; Dr Fessler and Dr Piquette for the Association of Pulmonary and Critical Care Medicine Program Directors.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):813-834. doi:10.1378/chest.14-0710
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This article describes the curricular milestones and entrustable professional activities for trainees in pulmonary, critical care, or combined fellowship programs. Under the Next Accreditation System of the Accreditation Council for Graduate Medical Education (ACGME), curricular milestones compose the curriculum or learning objectives for training in these fields. Entrustable professional activities represent the outcomes of training, the activities that society and professional peers can expect fellowship graduates to be able to perform unsupervised. These curricular milestones and entrustable professional activities are the products of a consensus process from a multidisciplinary committee of medical educators representing the American College of Chest Physicians (CHEST), the American Thoracic Society, the Society of Critical Care Medicine, and the Association of Pulmonary and Critical Care Medicine Program Directors. After consensus was achieved using the Delphi process, the document was revised with input from the sponsoring societies and program directors. The resulting lists can serve as a roadmap and destination for trainees, program directors, and educators. Together with the reporting milestones, they will help mark trainees’ progress in the mastery of the six ACGME core competencies of graduate medical education.

The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine (ABIM) are revising the processes by which training programs and trainees are evaluated. The tools for evaluation include reporting milestones, curricular milestones (CMs), and entrustable professional activities (EPAs). The purpose of this article is to describe the CMs and EPAs for fellowship training in pulmonary medicine, critical care medicine, and combined pulmonary and critical care medicine (PCCM) programs. CMs (also termed developmental milestones in the literature) are detailed lists of the specific components of the curriculum of a training program.1 Operationally, they can be considered the learning objectives for fellowship. EPAs represent the final products of fellowship training, the activities that both the medical profession and the public can trust a pulmonary and/or critical care medicine physician to perform independently.2,3 CMs and EPAs are elements in the process of measuring the effectiveness of medical training based on educational outcomes. This document does not create any new requirements for training programs. It organizes current requirements and existing curricula into a format that is congruent with the upcoming changes in program accreditation and trainee credentialing.

The ACGME is responsible to the public for the accreditation of residency and fellowship training programs, whereas the ABIM is responsible for certifying the competence of individual trainees in internal medicine and its subspecialties. The ACGME is implementing what has been termed the Next Accreditation System (NAS). The NAS constitutes a comprehensive revision of the methods for accreditation of medical training programs, and of how the educational progress of individual trainees is assessed.4,5 Thus, this aspect of the NAS represents a convergence of some of the goals of the ACGME and the ABIM.

In the NAS, the educational progress of trainees will be tracked and documented through a series of steps known as milestones. Milestones represent sets of discrete, observable, measurable behaviors that chart the progress of a trainee at all levels through increasing levels of competence, leading to independent practice. Milestones attempt to parse the somewhat abstract six core competencies of graduate medical education (medical knowledge, patient care, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice) into more concrete, quantifiable behaviors. The 22 reporting milestones (also termed subcompetencies) for internal medicine residents have been established and published, as have milestones for many of the other fields of medicine.68 Implementation of the reporting milestones in residency programs began in July 2013. The ACGME requires regularly scheduled reports on the progress of residents through these 22 reporting milestones.

Reporting milestones for the subspecialties of internal medicine have also been written, with input from the ACGME, ABIM, the Alliance for Academic Internal Medicine, and the major professional societies of all internal medicine subspecialties. That project produced a single, common set of reporting milestones that will be applicable to all fellowship programs. Like the internal medicine residency milestones on which they are largely based, the reporting milestones are intended to be “context free”; that is, the behaviors they describe are not constrained to single settings, specialties, or situations, but can be interpreted in the context of specific fellowship objectives. Beginning in July 2014, fellowship programs in internal medicine, including PCCM, will be required to implement these reporting milestones for the biannual assessment of fellows.9

In parallel with the writing of the common set of subspecialty reporting milestones, each of the subspecialties was charged to develop specific CMs and EPAs. In contrast to the reporting milestones, the CMs and EPAs are intended to be contextually grounded in each of the subspecialties, and will specify the unique curriculum of the subspecialties. With an appropriate degree of specificity, they list what program directors and supervisors expect fellows in PCCM training programs to learn, what we expect them to be able to do upon graduation, and, by implication, what we must teach them. They are the roadmaps and the goalposts for fellowship training and should serve as field guides for program directors and the clinical teaching faculty.

To achieve consensus on these EPAs and CMs, a working group was convened in March 2013. Membership was composed of two members each from the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), the American College of Chest Physicians (CHEST), the Society of Critical Care Medicine, and the American Thoracic Society. In addition to having clinical expertise in their respective fields, all members had significant experience as program directors of internal medicine residency or subspecialty fellowship training programs. In addition, several members were coauthors on prior publications of curricula in PCCM10 or were members of the Alliance for Academic Internal Medicine/ACGME/ABIM working group that wrote the common subspecialty reporting milestones.9

The working group held conference calls every 2 weeks, and had an in-person meeting in September 2013. Our deliberations were based on several foundational documents: the previously published curriculum for PCCM (itself based on a systematic literature review),10 the ACGME program requirements for PCCM fellowships,1113 the reporting milestones and CMs for internal medicine residency programs,6 the EPAs for internal medicine,3 and literature searches for other pulmonary or critical care curricula published since 2009.

The committee decided to develop separate, but overlapping, EPAs and CMs for pulmonary medicine and for critical care medicine. Combined PCCM fellowships would then use EPAs that combined both lists. The Delphi process was used to achieve consensus as follows: For the EPAs and each of the ACGME core competencies, a comprehensive list of potential CMs was compiled from the foundational documents. The lists were reviewed individually by the committee members, who were free to add to the lists based on their knowledge of the field. The lists were discussed during conference calls to eliminate obvious redundancies and gaps. These preliminary lists were then voted on by anonymous, web-based polling. Each potential CM was rated from 1 to 5, with 1 representing “definitely keep” and 5 representing “definitely eliminate.” After all members had voted, CMs with an average rating of ≤ 2 were retained (consensus to retain) and those rated ≥ 4 were rejected (consensus to reject). Items with intermediate ratings were discussed on the next conference call, during which modifications to the wording could also be proposed. In some cases, important milestones that appeared to be specific or measurable examples of more global milestones were retained as bullet points within that milestone. All indeterminate items underwent one or more subsequent rounds of voting until consensus to retain all remaining items was reached. This penultimate list was then reviewed for overlap or redundancy and consistent wording between the pulmonary and critical care versions.

The committee addressed the EPAs first, because they were fewer in number and because having the final goal of training in mind would inform deliberations on the process of training. Next, we addressed the CMs that fall under the four core competencies of practice-based learning, communication, professionalism, and systems-based practice. These core competencies are the least context specific. That is, we reasoned that trainees who behave professionally, who reflect upon and improve their own practice, who communicate well, and who work well within a health-care system as residents in internal medicine are likely to do so as fellows in PCCM. Therefore, the committee felt it was not necessary to add many more detailed CMs beyond the reporting milestones list. In addition, the CMs for these four core competencies could be identical for critical care medicine and pulmonary training.

Finally, during our face-to-face meeting, the committee addressed the CMs that fell under the core competencies of medical knowledge and patient care, including procedures. These were most numerous, and most specific to the specialty. Prior published curricula for critical care and for pulmonary medicine and the ACGME program requirements served as source documents. These extensive and overlapping source curricula were modified with the following considerations:

  • 1. Patient care and medical knowledge are fundamentally inseparable. Operationally, globally overarching topics were listed under medical knowledge, and disease- or procedure-specific topics were listed under patient care. However, the headings of both lists emphasize acquisition of the competence needed to apply medical knowledge to patient care.

  • 2. The final lists of CMs needed to be of manageable length, yet sufficiently detailed to provide specific guidance to program directors and trainees. This requirement entailed judicious grouping or splitting. Whenever feasible, diseases were grouped into categories, including a few specific examples as bulleted points. When grouping could have resulted in insufficient emphasis on important distinct diseases, the diseases were listed separately. The criteria for including a disease as a bullet point within a disease category were that it was either a common entity of broad importance or that it could lead to serious consequences if the diagnosis were missed.

  • 3. Procedures were listed in one of three categories: those that a trainee has to be able to perform independently (eg, bronchoscopy), those that the trainee must be able to interpret independently (eg, chest radiography), and those that the trainee needs to understand and use, but not perform or interpret independently (eg, open lung biopsy).

  • 4. Additional CMs were written to address the program requirements and reporting milestone for scholarly activity. Scholarly activity is required for fellowship, but not for residency training.

  • 5. The final list of medical knowledge and patient care milestones had to be congruent with the ACGME program requirements and ABIM competency requirements. Although there was considerable discussion about desirable changes to those requirements, we reasoned that program directors should not be faced with a curriculum that was inconsistent with current, published requirements.

After consensus was reached on all CMs, a draft document was written and submitted to the three sponsoring societies for comment. The document was further revised based on their suggestions. It was then circulated to all program directors of critical care, pulmonary, and combined PCCM programs for suggestions, and a final revision was approved by the sponsoring societies. This current, final document will also be submitted to the ACGME and ABIM as an informational item.

Consensus on all items was achieved in three or fewer rounds of Delphi voting. Because our in-person meeting facilitated active discussion and revision, only a single round of voting was required for the medical knowledge and patient care competencies, despite their length. Our final proposed EPAs for pulmonary medicine and critical care medicine are each shown separately in Table 1. Table 2 lists the EPAs for combined programs in pulmonary and critical care. Table 3 lists the CMs for the four common core competencies that are identical for pulmonary medicine, critical care medicine, and the combined field of PCCM. Table 3 also shows their relationship to the subcompetencies of the subspecialty reporting milestones. Note that these lists are identical for pulmonary trainees and for critical care medicine trainees. In recognition of the overlap between subcompetencies, we intentionally did not link each of our CMs to specific subcompetencies. Table 4 lists the medical knowledge and patient care CMs in a similar format, separately for pulmonary training and critical care medicine training. As anticipated because of their clinical focus, there are substantial differences between critical care and pulmonary medicine for these milestones. In Table 5, we combined the patient care and medical knowledge milestones for pulmonary medicine and critical care medicine. Many of these were similar milestones, with slightly different wording for each field. In those cases, they were reworded to reflect the broader of the two versions.

Table Graphic Jump Location
TABLE 1  ] Entrustable Professional Activities for Pulmonary Medicine and Critical Care Medicine
Table Graphic Jump Location
TABLE 2  ] Entrustable Professional Activities for Combined Pulmonary and Critical Care Medicine
Table Graphic Jump Location
TABLE 3  ] Curricular Milestones for Pulmonary Medicine, Critical Care Medicine, and Combined Pulmonary and Critical Care Medicine Training Programs for the Core Competencies of Systems-based Practice, Practice-based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism

ACGME = Accreditation Council for Graduate Medical Education.

Table Graphic Jump Location
TABLE 4  ] Medical Knowledge and Patient Care Curricular Milestones for Pulmonary Medicine and Critical Care Medicine

See Table 3 legend for expansion of abbreviation.

a 

Milestone in which the wording differs for pulmonary vs critical care.

b 

Elements for which competence is required for only one field or the other.

Table Graphic Jump Location
TABLE 5  ] Medical Knowledge and Patient Care Curricular Milestones for Pulmonary and Critical Care Medicine

This table combines the curricular milestones listed separately for pulmonary medicine and critical care medicine; where the wording of similar milestones differed between the two fields, the broader version was used. See Tables 3 legend for expansion of abbreviations.

Directors of training programs in straight pulmonary medicine or critical care medicine will, therefore, find their relevant EPAs and CMs listed in Tables 1, 3, and 4. Directors of combined training programs in pulmonary and critical care will use Tables 2, 3, and 5.

Using a formal process and with input from our professional societies and program directors, we have developed a list of CMs and EPAs for pulmonary medicine and critical care medicine. These documents serve several important goals. For the public, the EPAs provide a succinct summary of what subspecialists in our field can do and specify what trainees must be able to perform independently to ensure public trust. For trainees, the EPAs serve as a set of goals and reminders of what they must achieve.2,3 The CMs are a detailed list of expectations, the topics and skills that trainees must master to become independent practitioners.1 CM progress is condensed and summarized into the reporting milestones and will be reported to the ACGME.9 For the ACGME, program accreditation may be based in part on how well and consistently trainees master these milestones. Thus, these changes represent a new emphasis on how well the topics are learned (an outcome), rather than merely their inclusion in the curriculum (a process).14 For the ABIM, board eligibility for individual trainees can now be based on more specific, concrete, and measurable levels of competence.15,16 Finally, for program directors and educators, the CMs provide a comprehensive and uniform list of curricular content for fellowship training, a guide for evaluation of and feedback for trainees, and the database underlying the reporting milestones.

Although the final CMs are extensive, it is neither necessary nor expected that all fellows be assessed on all the numerous CMs. For example, consider the relationship between curricular content for a course and the course’s final examination. Content may be extensive, but need not all be on the final examination to grade the student. Similarly, a fellow may be assessed on only the most applicable CMs during any one clinical rotation. For example, some CMs will only be relevant to outpatient clinics, others to consultation or ICU rotations. Some CMs, such as professionalism or medical knowledge and care of the patient with COPD, will be taught and can be assessed in many settings during fellowship training. Others, such as knowledge and care of a patient with a rare lung disease, may have scarce opportunity for teaching or assessment. However, the goal over the course of fellowship training is for a larger picture to emerge from a series of snapshots. Fellows will learn their strengths and weaknesses, as will their program directors.

Full use of these CMs will require additional steps. First, program directors should review their current program structures to ensure that all these CMs are addressed in training. The specific formats with which they are taught will vary with local resources; common conditions or skills will be learned through didactics, study, and clinical experiences, whereas uncommon conditions may only be lectured on or discussed in the context of a differential diagnosis. Not all fellows will conduct primary investigation, although all should acquire the skills to critically appraise the medical literature and to present topics to colleagues.

Second, a subset of the CMs must be selected for the assessment of fellows’ competence during training, again based on the local resources and environment. Tools for assessment can then be devised to address the selected CMs. This important process is beyond the scope of this document. Assessment may be based on tools already in use for the assessment of residents using the internal medicine reporting milestones. Assessment tools for common use will also be developed and made available by the APCCMPD.

We recognize a number of concerns about and limitations to these CM lists. The first potential objection is the language we use. We have adopted the naming conventions used by the ACGME for the milestones.6,9 However, we believe these terminologies are abstruse, with significant potential to confuse. The reporting milestones have been referred to in the literature generically just as “milestones,” as “evaluation milestones,” and as “subcompetencies.” The term milestone has also been used to indicate the overall subcompetency (eg, “knowledge of diagnostic and testing procedures”), as well as the steps within that subcompetency that range from critical deficiency to aspirational achievement. The CMs that we present here have also been called “developmental milestones,” and do not include the discrete steps that have been published with the reporting milestones. We have shared our concern regarding this lexicon with the ACGME but we use their terminology consistently to avoid creating additional confusion.

Another concern we freely acknowledge is that not everyone will agree with the consensus lists of CMs and EPAs that we provide. Many program directors, educators, and trainees may feel we have included unnecessary content, excluded important areas, lumped or split topics too much, or worded some statements incorrectly. However, this is the nature of the consensus process. In support of our conclusions, our committee included broad expertise and experience in the clinical content, prior curriculum development in the field, ACGME and ABIM milestones, and the practical details of fellowship program management. Several of the authors (H. E. F., D. A.-H., J. D. B., S. M. P., C. A. P., and A. S.) participated in the writing of the internal medicine subspecialty reporting milestones.9 We used a formal and transparent consensus-building process. Although imperfect, the final lists of CMs and EPAs reconcile several overlapping lists, including the existing ACGME program requirements,1113 the competency and procedural skill measures used by the ABIM,15 and published curricula for PCCM.10 Our lists are similar in length and detail to those that have been developed for other subspecialties and residency programs. Program directors, however, are free to emphasize topics to a greater or lesser degree based on their preferences and local resources.

Finally, there are medical knowledge and patient care items that will diverge increasingly from evolving medical care. We are cognizant, however, of the requirements of the ACGME and of the ABIM, which may lag behind current practices. For example, fellows in both pulmonary training and critical care training must demonstrate competence in the insertion of pulmonary artery floatation catheters,11,12 despite the decreasing frequency of their use.17,18 Other procedures and technologies, such as endobronchial ultrasound, percutaneous tracheostomy, or electromagnetic navigation, may evolve toward being standards of care, whereas others, such as closed pleural biopsy, will become extinct. We are hopeful that the patient care and medical knowledge CMs will be living documents that evolve with changes in medical practice. This may be achieved through regular review and revision by the APCCMPD, a suggestion to which that organization has been receptive. Furthermore, we would greatly prefer that this list, derived with contemporary input from content experts within our subspecialty, be the driver of ACGME and ABIM regulations, rather than the converse. However, the process of revising those regulations may be lengthy, and our influence limited. In the interim, it is essential that our required curriculum as detailed here does not conflict with other published regulatory requirements.

In summary, this article proposes the curriculum milestones and EPAs that we believe define the practice of PCCM. These documents explain succinctly to the public, to legislators, to payers, and to our colleagues who we are and what we do. Together, these documents compose the destinations for fellowship training and the maps to guide us there.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: The authors are extremely grateful for the administrative support from Joyce Bruno, MBA, MIPH, and Laura Nolan from the Association of Pulmonary and Critical Care Medicine Program Directors, and Sharon Plenner, BS, from the Society of Critical Care Medicine.

ABIM

American Board of Internal Medicine

ACGME

Accreditation Council for Graduate Medical Education

APCCMPD

Association of Pulmonary and Critical Care Medicine Program Directors

CM

curricular milestone

EPA

entrustable professional activity

NAS

Next Accreditation System

PCCM

pulmonary and critical care medicine

Green ML, Aagaard EM, Caverzagie KJ, et al. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ. 2009;1(1):5-20. [CrossRef] [PubMed]
 
ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82(6):542-547. [CrossRef] [PubMed]
 
Hauer KE, Soni K, Cornett P, et al. Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study. J Gen Intern Med. 2013;28(8):1110-1114. [CrossRef] [PubMed]
 
Next Accreditation System. Accreditation Council for Graduate Medical Education website. http://www.acgme-nas.org/. Accessed June 13, 2014.
 
Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. N Engl J Med. 2012;366(11):1051-1056. [CrossRef] [PubMed]
 
Caverzagie KJ, Iobst WF, Aagaard EM, et al. The internal medicine reporting milestones and the next accreditation system. Ann Intern Med. 2013;158(7):557-559. [CrossRef] [PubMed]
 
Hicks PJ, Englander R, Schumacher DJ, et al. Pediatrics milestone project: next steps toward meaningful outcomes assessment. J Grad Med Educ. 2010;2(4):577-584. [CrossRef] [PubMed]
 
Hicks PJ, Schumacher DJ, Benson BJ, et al. The pediatrics milestones: conceptual framework, guiding principles, and approach to development. J Grad Med Educ. 2010;2(3):410-418. [CrossRef] [PubMed]
 
The Internal Medicine Subspecialty Milestones Project. Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/InternalMedicineSubspecialtyMilestones.pdf. Accessed June 13, 2014.
 
Buckley JD, Addrizzo-Harris DJ, Clay AS, et al. Multisociety task force recommendations of competencies in Pulmonary and Critical Care Medicine. Am J Respir Crit Care Med. 2009;180(4):290-295. [CrossRef] [PubMed]
 
ACGME program requirements for graduate medical education in critical care medicine. Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/142_critical_care_int_med_07132013.pdf. Accessed June 13, 2014.
 
ACGME program requirements for graduate medical education in pulmonary disease. Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/149_pulmonary_disease_int_med_07132013.pdf. Accessed June 13, 2014.
 
ACGME program requirements for graduate medical education in pulmonary disease and critical care medicine (internal medicine). Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/156_pulmonary_critical_care_int_med_07132013.pdf. Accessed June 13, 2014.
 
Weinberger SE, Pereira AG, Iobst WF, Mechaber AJ, Bronze MS; Alliance for Academic Internal Medicine Education Redesign Task Force II. Competency-based education and training in internal medicine. Ann Intern Med. 2010;153(11):751-756. [CrossRef] [PubMed]
 
Critical care medicine policies. American Board of Internal Medicine website. http://www.abim.org/certification/policies/imss/ccm.aspx. Accessed June 13, 2014.
 
Pulmonary disease policies. American Board of Internal Medicine website. http://www.abim.org/certification/policies/imss/pulm.aspx. Accessed June 13, 2014.
 
Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA. 2007;298(4):423-429. [PubMed]
 
Gershengorn HB, Wunsch H. Understanding changes in established practice: pulmonary artery catheter use in critically ill patients. Crit Care Med. 2013;41(12):2667-2676. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
TABLE 1  ] Entrustable Professional Activities for Pulmonary Medicine and Critical Care Medicine
Table Graphic Jump Location
TABLE 2  ] Entrustable Professional Activities for Combined Pulmonary and Critical Care Medicine
Table Graphic Jump Location
TABLE 3  ] Curricular Milestones for Pulmonary Medicine, Critical Care Medicine, and Combined Pulmonary and Critical Care Medicine Training Programs for the Core Competencies of Systems-based Practice, Practice-based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism

ACGME = Accreditation Council for Graduate Medical Education.

Table Graphic Jump Location
TABLE 4  ] Medical Knowledge and Patient Care Curricular Milestones for Pulmonary Medicine and Critical Care Medicine

See Table 3 legend for expansion of abbreviation.

a 

Milestone in which the wording differs for pulmonary vs critical care.

b 

Elements for which competence is required for only one field or the other.

Table Graphic Jump Location
TABLE 5  ] Medical Knowledge and Patient Care Curricular Milestones for Pulmonary and Critical Care Medicine

This table combines the curricular milestones listed separately for pulmonary medicine and critical care medicine; where the wording of similar milestones differed between the two fields, the broader version was used. See Tables 3 legend for expansion of abbreviations.

References

Green ML, Aagaard EM, Caverzagie KJ, et al. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ. 2009;1(1):5-20. [CrossRef] [PubMed]
 
ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82(6):542-547. [CrossRef] [PubMed]
 
Hauer KE, Soni K, Cornett P, et al. Developing entrustable professional activities as the basis for assessment of competence in an internal medicine residency: a feasibility study. J Gen Intern Med. 2013;28(8):1110-1114. [CrossRef] [PubMed]
 
Next Accreditation System. Accreditation Council for Graduate Medical Education website. http://www.acgme-nas.org/. Accessed June 13, 2014.
 
Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. N Engl J Med. 2012;366(11):1051-1056. [CrossRef] [PubMed]
 
Caverzagie KJ, Iobst WF, Aagaard EM, et al. The internal medicine reporting milestones and the next accreditation system. Ann Intern Med. 2013;158(7):557-559. [CrossRef] [PubMed]
 
Hicks PJ, Englander R, Schumacher DJ, et al. Pediatrics milestone project: next steps toward meaningful outcomes assessment. J Grad Med Educ. 2010;2(4):577-584. [CrossRef] [PubMed]
 
Hicks PJ, Schumacher DJ, Benson BJ, et al. The pediatrics milestones: conceptual framework, guiding principles, and approach to development. J Grad Med Educ. 2010;2(3):410-418. [CrossRef] [PubMed]
 
The Internal Medicine Subspecialty Milestones Project. Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/InternalMedicineSubspecialtyMilestones.pdf. Accessed June 13, 2014.
 
Buckley JD, Addrizzo-Harris DJ, Clay AS, et al. Multisociety task force recommendations of competencies in Pulmonary and Critical Care Medicine. Am J Respir Crit Care Med. 2009;180(4):290-295. [CrossRef] [PubMed]
 
ACGME program requirements for graduate medical education in critical care medicine. Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/142_critical_care_int_med_07132013.pdf. Accessed June 13, 2014.
 
ACGME program requirements for graduate medical education in pulmonary disease. Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/149_pulmonary_disease_int_med_07132013.pdf. Accessed June 13, 2014.
 
ACGME program requirements for graduate medical education in pulmonary disease and critical care medicine (internal medicine). Accreditation Council for Graduate Medical Education website. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/156_pulmonary_critical_care_int_med_07132013.pdf. Accessed June 13, 2014.
 
Weinberger SE, Pereira AG, Iobst WF, Mechaber AJ, Bronze MS; Alliance for Academic Internal Medicine Education Redesign Task Force II. Competency-based education and training in internal medicine. Ann Intern Med. 2010;153(11):751-756. [CrossRef] [PubMed]
 
Critical care medicine policies. American Board of Internal Medicine website. http://www.abim.org/certification/policies/imss/ccm.aspx. Accessed June 13, 2014.
 
Pulmonary disease policies. American Board of Internal Medicine website. http://www.abim.org/certification/policies/imss/pulm.aspx. Accessed June 13, 2014.
 
Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA. 2007;298(4):423-429. [PubMed]
 
Gershengorn HB, Wunsch H. Understanding changes in established practice: pulmonary artery catheter use in critically ill patients. Crit Care Med. 2013;41(12):2667-2676. [CrossRef] [PubMed]
 
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