Transition between Residency and Fellowship: A National Study of the Longitudinal Alignment between ACGME Milestones for General Surgery Residency and Subsequent Vascular Surgery Fellowship.

内容摘要

To understand residency to fellowship transition by exploring the alignment of graduating general surgery (GS) residency and early vascular surgery fellowship (VSF) ACGME Milestones 2.0 competencies. Milestones 2.0 presents an opportunity to evaluate trainee progression from residency through fellowship. Understanding the residency-fellowship alignment of Milestones ratings is important for the training continuum and identifying early signals for struggling learners during this transition. This is a retrospective national study of two VSF cohorts (starting 2022 and 2023) who previously completed GS residency. We compared ACGME Milestones 2.0 ratings from the final 2 years of residency to year-1 VSF using descriptive statistics and linear mixed effects regression models. Milestones data were collected for vascular surgery fellows (n=266). Results showed significant PGY-5 GS-VSF predictive alignment for PC (&#x3b2;=0.20, P=0.004); MK (&#x3b2;=0.13, P=0.027); PROF (&#x3b2;=0.23, P<0.001); and ICS (&#x3b2;=0.17, P=0.01). These results translate to a mean fellowship Milestones level difference between learners up to 0.49 to 0.64 units for every 1-unit difference in Milestones between GS residents. SBP and PBLI ratings were not significantly aligned. Matched subcompetencies showed significant alignment (3 of 4 PC, 2 of 2 MK, 4 of 4 PROF, 2 of 3 ICS). The alignment between graduating GS residents and VSF year-1 Milestones ratings for PC, MK, PROF, and ICS demonstrates a continuum in educational outcomes and potential use to facilitate the residency-fellowship transition. These findings may support using Milestones 2.0 for residency-fellowship hand-off and performance analytics that may serve as early feedback to support trainees.