EPA & Milestones for Residency
In alignment with the World Health Organization’s international direction toward competency-based medical education (CBME), the training of emergency medicine residents incorporates Entrustable Professional Activities (EPAs) and the Milestone Project.
The Taiwan Society of Emergency Medicine (TSEM) has implemented the Milestone Project, which organizes the medical knowledge, skills, attitudes, and other core competencies required of physicians into a longitudinal developmental framework progressing from basic to advanced levels. As physicians enter residency training following graduation from medical school, these milestones serve as descriptors of resident performance and developmental targets throughout residency training.
The framework is based on the six core competencies established by the Accreditation Council for Graduate Medical Education (ACGME): Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice. These six core competencies provide the overall direction for the competencies required during residency training.
The milestones are designed in a convenient checklist format to facilitate future alignment with the development of emergency medicine education by the Taiwan Society of Emergency Medicine and relevant national medical education policies. It is anticipated that a regular reporting system for residents’ milestone development during training will be implemented in the future. This initiative is currently in the planning stage, and feedback and suggestions from colleagues in emergency medicine are welcomed regarding its implementation.
For future reporting of residents’ milestone development, evaluators may use various assessment tools as objective evidence, including direct observation, multi-source feedback, and written tests, to determine the resident’s current level of performance for each milestone. These assessments are used to determine whether the resident has consistently achieved the requirements of the current level as well as all requirements at the preceding levels.
The milestones for each sub-competency are divided into five levels, with the following meanings:
Level 1: The resident demonstrates the level of performance expected of an incoming resident.
Level 2: The resident has made progress but has not yet reached a mid-residency level of performance.
Level 3: The resident continues to progress and has achieved most of the requirements of the milestone for this sub-competency at the residency level.
Level 4: The resident has demonstrated achievement of the training objectives for this milestone sub-competency. This level represents the degree of competency expected for graduation from emergency medicine specialty training.
Level 5: The resident has exceeded the requirements established for residency training in this area and has reached an expert level. Only a very small number of exceptional residents are expected to reach this level.
Level 4 is designed as the graduation target for emergency medicine specialty training and does not represent a graduation requirement.
Specialist Training in Geriatric Emergency Medicine