• Brigitte K Smith, Kenji Yamazaki, Ara Tekian, Eric Holmboe, Stanley J Hamstra, Erica L Mitchell, and Yoon Soo Park.
• Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT.
• Ann. Surg. 2023 Apr 1; 277 (4): e971e977e971-e977.

ObjectiveThis study aims to investigate at-risk scores of semiannual Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings for vascular surgical trainees' final achievement of competency targets.Summary Background DataACGME Milestones assessments have been collected since 2015 for Vascular Surgery. It is unclear whether milestone ratings throughout training predict achievement of recommended performance targets upon graduation.MethodsNational ACGME Milestones data were utilized for analyses. All trainees completing 2-year vascular surgery fellowships in June 2018 and 5-year integrated vascular surgery residencies in June 2019 were included. A generalized estimating equations model was used to obtain at-risk scores for each of the 31 subcompetencies by semiannual review periods, to estimate the probability of trainees achieving the recommended graduation target based on their previous ratings.ResultsA total of 122 vascular surgery fellows (VSFs) (95.3%) and 52 integrated vascular surgery residents (IVSRs) (100%) were included. VSFs and IVSRs did not achieve level 4.0 competency targets at a rate of 1.6% to 25.4% across subcompetencies, which was not significantly different between the 2 groups for any of the subcompetencies ( P = 0.161-0.999). Trainees were found to be at greater risk of not achieving competency targets when lower milestone ratings were assigned, and at later time-points in training. At a milestone rating of 2.5, with 1 year remaining before graduation, the at-risk score for not achieving the target level 4.0 milestone ranged from 2.9% to 77.9% for VSFs and 33.3% to 75.0% for IVSRs.ConclusionThe ACGME Milestones provide early diagnostic and predictive information for vascular surgery trainees' achievement of competence at completion of training.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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