Reader Response: Introducing the Neurology Milestones 2.0
Arielle MKurzweil, Neurologist, NYU Grossman School of Medicine
Submitted March 16, 2022
I was interested to read about the development and introduction of Neurology Milestones 2.0 in the article by Dewey et al.1 It seems that the goal of reducing milestone complexity and variability has been met. What I think remains unclear are the best tools and resources to assess milestones, and how best to provide objective feedback to trainees based on milestones. The supplemental guide does offer some assistance in this matter, though most traditional methods of assigning milestone scores are subjective and may not correlate well with actual performance. Faculty may hesitate to put in writing genuine assessments for concern that they may adversely affect their relationship with the trainee. The authors highlight an example where a graduating resident assessment showed no correlation between their performance during a simulated case and level of milestone achievement. I am not convinced that such an issue would be resolved with Milestones 2.0, since a truly objective method to collect evaluative data is not provided. Simulation can indeed provide an objective and standardized experience to residents that allows for consistent assessment across learners, as opposed to different faculty graders across rotations. It can be used to teach and assess the various ACGME core competencies, as in communication and professionalism.2 Until more guidelines are in place and there are better tools to assess milestones, it seems inevitable that there will be important questions about how they predict future resident performance.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Dewey JJ, Chiota-McCollum N, Barratt D, et al. Introducing the Neurology Milestones 2.0. Neurology. 2022;98(9):366-372. doi:10.1212/WNL.0000000000013312
Kurzweil AM, Lewis A, Pleninger P, et al. Education Research: Teaching and assessing communication and professionalism in neurology residency with simulation. Neurology. 2020;94(5):229-232. doi:10.1212/WNL.0000000000008895
I was interested to read about the development and introduction of Neurology Milestones 2.0 in the article by Dewey et al.1 It seems that the goal of reducing milestone complexity and variability has been met. What I think remains unclear are the best tools and resources to assess milestones, and how best to provide objective feedback to trainees based on milestones. The supplemental guide does offer some assistance in this matter, though most traditional methods of assigning milestone scores are subjective and may not correlate well with actual performance. Faculty may hesitate to put in writing genuine assessments for concern that they may adversely affect their relationship with the trainee. The authors highlight an example where a graduating resident assessment showed no correlation between their performance during a simulated case and level of milestone achievement. I am not convinced that such an issue would be resolved with Milestones 2.0, since a truly objective method to collect evaluative data is not provided. Simulation can indeed provide an objective and standardized experience to residents that allows for consistent assessment across learners, as opposed to different faculty graders across rotations. It can be used to teach and assess the various ACGME core competencies, as in communication and professionalism.2 Until more guidelines are in place and there are better tools to assess milestones, it seems inevitable that there will be important questions about how they predict future resident performance.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References