A Milestone is a developmental benchmark used by the Accreditation Council for Graduate Medical Education (ACGME) to evaluate a medical resident’s progression in key competencies throughout their training.
🧠 In practice, a milestone is:
A narrative descriptor of observable behaviors or skills expected at different stages of residency (Levels 1 to 5).
Used in semiannual evaluations to track progress across domains like Patient Care, Medical Knowledge, Professionalism, Systems-Based Practice, Communication, and Practice-Based Learning and Improvement.
🔢 Milestone levels (simplified): Level 1 – Beginner: Just entering residency
Level 2–3 – Intermediate: Developing skills, needs supervision
✅ Level 4 – Expected competence at graduation
Level 5 – Aspirational: Fellow-level or advanced practitioner
⚠️ Critical note: While designed to standardize evaluation, milestones risk becoming reductionist if used rigidly. They can oversimplify complex clinical growth and prioritize checkbox compliance over nuanced judgment and professional identity.
📌 In short:
Milestone = a structured descriptor of what a resident “should” be able to do at a given point — useful for guidance, but not a substitute for clinical intuition or holistic evaluation.