The Promise of Milestones: Are They Living Up to Our Expectations?

B eginning in 2013, the Accreditation Council for Graduate Medical Education (ACGME) required program directors to semiannually report milestone data for their trainees. The milestones are competency-based observable behaviors that mark a trainee’s developmental progression toward unsupervised practice by enhancing learner assessment and feedback and program evaluation and improvement. The aim is to help ‘‘residencies and fellowships produce highly competent physicians to meet the health and health care needs of the public.’’ This raises the question: Are the milestones meeting that goal? Specifically, what is the validity evidence that supports the use of milestones to ‘‘produce highly competent physicians’’? Validity evidence includes content validity, internal structure, response process, relationship to other variables, and consequences. This commentary highlights some of the validity evidence supporting the use of milestones, and outlines areas where further research is needed.