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Simplifying the Milestones

Sillah, Nyama M. MD*; Lau, Frank H. MD; Lin, Samuel J. MD*

Plastic and Reconstructive Surgery – Global Open: March 2015 - Volume 3 - Issue 3 - p e354
doi: 10.1097/GOX.0000000000000319
2014 ACAPS Congress: Abstracts

*From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; and Division of Plastic Surgery, Louisiana State University, New Orleans, La.

Presented at the American Council of Academic Plastic Surgeons Winter Retreat, December 6–7, 2014, Chicago, Ill.

IRB exemption was granted by our medical center review board.

Disclosure: Dr. Lau and Dr. Lin are co-founders of Simple Milestones, the software platform discussed in this abstract. Dr. Sillah has no financial disclosures. The article processing charge for this abstract was paid for by the American Council of Academic Plastic Surgeons.

Samuel J. Lin, MD, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA 02215, E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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The Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS) milestones were implemented for plastic surgery programs in July 2014. The new system, however, poses a new challenge to staff due to the vast amount of data that need to be collected for each trainee. For example, for every plastic surgery resident, there are 36 milestones comprising 432 checkpoints. Per the ACGME, milestones are to be collated biannually. Collecting these many data points on multiple residents poses a dilemma of being a significant logistical data collection challenge from faculty. Our goal was to develop an efficient computer software platform to both increase data collection/response rate from faculty and collate results for ACGME reporting in an efficient manner.

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A computer software platform was developed as a resource to assist 4 main groups: faculty, clinical competency committee (CCC), residency program administrators, and residents to expeditiously evaluate and to collect milestone data points. The participant is able to choose an interface: a text message, a smartphone browser, or a web browser. The software prompts a response about a specific resident on a milestone checkpoint by sending an e-mail or text message notification when a response is due. Questions are presented in a 1-click yes or no format, and each question correlates to a specific milestone. The software then automates data collection and generates reports on each resident. The goal of the software is to simplify data collection and generate meaningful evidence-based reports about resident performance. The software utilizes Secure Sockets Layer encryption, utilizes industry-standard data separation, and is backed up daily to a cloud service. Regular software upgrades are performed in response to changes in the ACGME requirements and participate feedback.

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The software platform was launched in July 2014 and was introduced more broadly at the American Council of Academic Plastic Surgeons (ACAPS) Coordinator Meeting at the American Society of Plastic Surgeons in October 2014 and at the ACAPS Winter Retreat in December 2014. The software is currently being used at pilot ACGME-accredited Plastic Surgery residency programs across the country with other ACGME fields in the process. Preliminary data demonstrate that the average faculty completion time for a checkpoint is 40 seconds. Early experience reported by residency programs at ACGME workshops indicated that CCC meetings could take 2–3 days. The software platform has been used at our institution since its launch. In the Harvard residency program, our first CCC meeting to discuss 27 residents’ milestones took 2.5 hours to complete, and we anticipate future CCC meetings to be potentially more efficient.

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The NAS has been implemented nationwide for all plastic surgery training programs. Milestone-based resident training is a new paradigm for residency training evaluation; training programs are in the process of making this transition to find ways to make milestone data meaningful for faculty and residents; however, the vast amount of data points that need to be collected per residents can seem overwhelming. We have developed a user-friendly computer software platform that allows easy and efficient collection of data points. The software currently is being used at pilot residency programs, and development with other surgical specialty fields is underway.

© 2015 American Society of Plastic Surgeons