Share this article on:

Playing With Curricular Milestones in the Educational Sandbox: Q-sort Results From an Internal Medicine Educational Collaborative

Meade, Lauren B. MD; Caverzagie, Kelly J. MD; Swing, Susan R. PhD; Jones, Ron R. MD; O’Malley, Cheryl W. MD; Yamazaki, Kenji PhD; Zaas, and Aimee K. MD, MHS

doi: 10.1097/ACM.0b013e31829a3967
Research Reports

Purpose In competency-based medical education, the focus of assessment is on learner demonstration of predefined outcomes or competencies. One strategy being used in internal medicine (IM) is applying curricular milestones to assessment and reporting milestones to competence determination. The authors report a practical method for identifying sets of curricular milestones for assessment of a landmark, or a point where a resident can be entrusted with increased responsibility.

Method Thirteen IM residency programs joined in an educational collaborative to apply curricular milestones to training. The authors developed a game using Q-sort methodology to identify high-priority milestones for the landmark “Ready for indirect supervision in essential ambulatory care” (EsAMB). During May to December 2010, the programs’ambulatory faculty participated in the Q-sort game to prioritize 22 milestones for EsAMB. The authors analyzed the data to identify the top 8 milestones.

Results In total, 149 faculty units (1–4 faculty each) participated. There was strong agreement on the top eight milestones; six had more than 92% agreement across programs, and five had 75% agreement across all faculty units. During the Q-sort game, faculty engaged in dynamic discussion about milestones and expressed interest in applying the game to other milestones and educational settings.

Conclusions The Q-sort game enabled diverse programs to prioritize curricular milestones with interprogram and interparticipant consistency. A Q-sort exercise is an engaging and playful way to address milestones in medical education and may provide a practical first step toward using milestones in the real-world educational setting.

Dr. Meade is assistant professor, Department of Medicine, Tufts University School of Medicine, associate program director for internal medicine, Baystate Health, and chair, Educational Research Outcomes Collaborative, Internal Medicine, Baystate Health, Springfield, Massachusetts.

Dr. Caverzagie is associate vice chair for quality and physician competence, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.

Dr. Swing is vice president, Outcome Assessment, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

Dr. Jones is associate director, Internal Medicine Residency, Summa Health System, and associate professor of internal medicine, Northeast Ohio Medical University, Rootstown, Ohio.

Dr. O’Malley is director, Internal Medicine Residency Program, Banner Good Samaritan Medical Center, and assistant professor of medicine, University of Arizona College of Medicine, Phoenix, Arizona.

Dr. Yamazaki is outcome assessment research associate, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

Dr. Zaas is associate professor, Division of Infectious Diseases and International Health, Department of Medicine, and program director, Internal Medicine Residency, Duke University School of Medicine, Durham, North Carolina.

Supplemental digital content for this article is available at

Correspondence should be addressed to Dr. Meade, 759 Chestnut St., Springfield, MA 01199; telephone: (413) 794-8121; e-mail:

© 2013 by the Association of American Medical Colleges