ImportanceNational data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates.ObjectiveTo evaluate the association of in-training ACGME Milestone ratings in a surgical specialty with subsequent complication rates following a commonly performed operation, endovascular aortic aneurysm repair (EVAR).Design, Setting, and ParticipantsThis study of patient outcomes followed EVAR in the Vascular Quality Initiative (VQI) registry (4213 admissions from 208 hospitals treated by 327 surgeons). All surgeons included in this study graduated from ACGME-accredited training programs from 2015 through 2019 and had Milestone ratings 6 months prior to graduation. Data were analyzed from December 1, 2021, through September 15, 2023. Because Milestone ratings can vary with program, they were corrected for program effect using a deviation score from the program mean.ExposureMilestone ratings assigned to individual trainees 6 months prior to graduation, based on judgments of surgical competence.Main Outcomes and MeasuresSurgical complications following EVAR for patients treated by recent graduates during the index hospitalization, obtained using the nationwide Society for Vascular Surgery Patient Safety Organization’s VQI registry, which includes 929 participating centers in 49 US states.ResultsThe study included outcomes for 4213 patients (mean [SD] age, 73.25 [8.74] years; 3379 male participants [80.2%]). Postoperative complications included 9.5% major (400 of 4213 cases) and 30.2% minor (1274 of 4213 cases) complications. After adjusting for patient risk factors and site of training, a significant association was identified between individual Milestone ratings of surgical trainees and major complications in early surgical practice in programs with lower mean Milestone ratings (odds ratio, 0.50; 95% CI; 0.27-0.95).Conclusions and RelevanceIn this study, Milestone assessments of surgical trainees were associated with subsequent clinical outcomes in their early career. Although these findings represent one surgical specialty, they suggest Milestone ratings can be used in any specialty to identify trainees at risk for future adverse patient outcomes when applying the same theory and methodology. Milestones data should inform data-driven educational interventions and trainee remediation to optimize future patient outcomes.

中文翻译：

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研究生医学教育认证委员会里程碑培训评级和外科医生的早期成果

重要性关于培训期间能力发展的国家数据已使用研究生医学教育认证委员会 (ACGME) 里程碑系统报告。现在可以考虑纵向分析，将培训期间的里程碑评级与应届毕业生的患者结果数据联系起来。目的评估外科专业培训中 ACGME 里程碑评级与常见手术（血管内主动脉瘤）随后的并发症发生率之间的关联设计、设置和参与者这项患者结果研究遵循血管质量倡议 (VQI) 登记处的 EVAR（来自 208 家医院的 4213 名入院患者，由 327 名外科医生治疗）。本研究中包含的所有外科医生均毕业于 2015 年至 2019 年 ACGME 认可的培训项目，并在毕业前 6 个月获得了里程碑评级。数据分析时间为 2021 年 12 月 1 日至 2023 年 9 月 15 日。由于里程碑评级可能因计划而异，因此使用与计划平均值的偏差分数对计划效果进行了校正。ExposureMilestone 评级在毕业前 6 个月分配给个别学员，主要结果和措施近期毕业生在指数住院期间接受 EVAR 治疗的患者的手术并发症，通过全国血管外科学会患者安全组织的 VQI 登记处获得，该登记处包括美国 49 个州的 929 个参与中心。 结果研究包括 4213 名患者的结果（平均 [SD] 年龄，73.25 [8.74] 岁；3379 名男性参与者 [80.2%]）。术后并发症包括 9.5% 的严重并发症（4213 例中的 400 例）和 30.2% 的轻微并发症（4213 例中的 1274 例）。在调整患者风险因素和培训地点后，在平均里程碑评级较低的项目中，外科受训者的个人里程碑评级与早期手术实践中的主要并发症之间存在显着关联（比值比，0.50；95% CI；0.27-0.95） ).结论和相关性在这项研究中，外科实习生的里程碑评估与其早期职业生涯中的后续临床结果相关。尽管这些发现代表了一种外科专业，但他们建议里程碑评级可用于任何专业，以识别在应用相同的理论和方法时面临未来不良患者结果风险的受训者。里程碑数据应为数据驱动的教育干预和学员补救提供信息，以优化未来的患者治疗结果。