https://clinfowiki.org/wiki/api.php?action=feedcontributions&user=Sgebauer&feedformat=atomClinfowiki - User contributions [en]2024-03-28T09:13:15ZUser contributionsMediaWiki 1.22.4https://clinfowiki.org/wiki/index.php/Main_PageMain Page2015-04-23T23:29:09Z<p>Sgebauer: /* Academics and Education */</p>
<hr />
<div>'''Welcome to the OHSU Clinfowiki'''<br />
<br />
The OHSU Clinical Informatics Wiki (aka ClinfoWiki) is the implementation of a [http://en.wikipedia.org/wiki/Wiki wiki] website devoted to topics in [[Biomedical Informatics]]. <br />
<br />
The Department of Medical Informatics & Clinical Epidemiology (DMICE) is one of 27 academic departments in the School of Medicine at Oregon Health & Science University (OHSU). The mission of DMICE is to provide leadership, discovery and dissemination of knowledge in clinical informatics, clinical epidemiology, and bioinformatics / computation biology. This mission is fulfilled through programs of research, education, and service. DMICE programs are recognized internationally for their accomplishment and innovation. The OHSU Biomedical Informatics program is one of the largest of its kind in the world. <br />
<br />
Clinfowiki is edited by [http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/dmice/people/vishnu-mohan.cfm Vishnu Mohan, M.D., M.B.I.], and was created in 2005 by [http://www.uthouston.edu/sbmi/faculty-and-staff/dean-sittig.htm Dean F. Sittig, Ph.D.].<br />
<br />
To begin a new article, or edit an existing article, you must first create an account and login to the ClinfoWiki. The site can be browsed by anyone.<br />
<br />
[[Special:ActiveUsers|We]] are currently working on [[Special:Statistics|{{NUMBEROFARTICLES}}]] articles, and we '''[[Clinfowiki To Do|need your help]]''' to complete this study of Informatics. See [[Special:Statistics]] for more complete information on the site.<br />
<br />
The Clinfowiki has recently been reorganized into the <u>20</u> categories below. When adding (or editing) content, please try to ensure the content traces back to one of these categories.<br />
<br />
<br />
=[[:Category:Technologies | Technologies]]=<br />
<br />
==[[:Category: EHR | Electronic Medical Record (EMR)]]==<br />
* [[EHR | What is the Electronic Medical Record]]<br />
* [[EMR v. EHR]]<br />
* [[EHR-enabled Research]]<br />
* [[Security of the distributed electronic patient record: a case-based approach to identifying policy issues]]<br />
<br />
==[[:Category: CPOE | Computerized Physician Order Entry (CPOE)]]==<br />
* [[CPOE | Computerized Physician Order Entry]]<br />
* [[Barcode medication administration]]<br />
* [[E-prescribing | Electronic Prescribing (E-prescribing)]]<br />
<br />
==[[:Category: CDS | Clinical Decisions Support (CDS)]]==<br />
* [[CDS | Clinical Decisions Support]]<br />
* [[Timeline of the Development of Clinical Decision Support]]<br />
* [[The Evolution of Clinical Decision Support]]<br />
* [[Decision Support Service]]<br />
* [[Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department]]<br />
<br />
==[[:Category: PHR | Personal Health Record (PHR)]]==<br />
* [[PHR | Personal Health Records]]<br />
* [[PHA | Personal Health Applications]]<br />
<br />
==[[:Category: Reviews | Reviews of scientific papers]]==<br />
<br />
==[[:Category:Integrated Data Repositories (IDR) | Integrated Data Repositories (IDR)]]==<br />
* [[CIDR | Clinical Integrated Data Repositories (CIDR)]]<br />
<br />
==[[:Category:Ancillary Systems | Ancillary Systems]]==<br />
* [[Ancillary Clinical Information Systems]]<br />
* [[BioBanking | Biobanking -- a.k.a. Biorepositories or Tissue Bank]]<br />
* [[Anesthesia Information Management Systems (AIMS)]]<br />
<br />
==[[:Category:Medical Devices | Medical Devices]]==<br />
<DynamicPageList><br />
category = Medical Devices<br />
</DynamicPageList><br />
* [[mHealth]]<br />
<br />
==[[:Category:Other Technologies | Other Technologies]]==<br />
* [[:Category:New_Technology| New CIS-related Technologies]]<br />
* [[FOSSM | Free and Open Source Software (FOSS) licensing in medicine]]<br />
* [[Unintended Consequences of HIT]]<br />
* [[i2b2 Informatics for Integrating Biology and the Bedside]]<br />
* [[The Cloud and it's impact on Health IT]]<br />
<br />
=[[:Category:Applications | Applications]]=<br />
<br />
==[[:Category:Evidence Based Medicine (EBM) | Evidence Based Medicine (EBM)]]==<br />
* [[EBM | Evidence Based Medicine]]<br />
* Rationale, design,and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care<br />
* [[Efficacy of an Evidence-Based Clinical Decision Support in Primary Care Practices A Randomized Clinical Trial]]<br />
<br />
==[[:Category:Methodologies and Frameworks | Methodologies and Frameworks]]==<br />
* [[Evaluation and Design Methodologies]]<br />
* [[The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation]]<br />
* [[Sociotechnical systems]]<br />
<br />
==[[:Category:Government, Public and Private Initiatives | Government, Public and Private Initiatives]]==<br />
* [[HITREC | Health Information Technology Regional Extension Centers (HITREC)]]<br />
* [[RHIO | Regional Health Information Organization (RHIO)]]<br />
* [[NHIN | Nationwide Health Information Network (NwHIN)]]<br />
* [[Assistant Secretary for Planning & Evaluation]] <br />
* [[Office of the National Coordinator for Health Information Technology (ONC)]] <br />
* [[Council on the Application of Health Information Technology (CAHIT)]] <br />
* [[Agency for Healthcare Research and Quality (AHRQ)]] <br />
* [[Centers for Medicare and Medicaid Services (CMS)]] <br />
* [[U.S. Food and Drug Administration (FDA)]] <br />
* [[National Institutes of Health (NIH)]] <br />
* [[Big Data to Knowledge (BD2K)]]<br />
* [[Indian Health Service (IHS)]] <br />
* [[Health Services and Resource Administration (HRSA)]] <br />
* [[Centers for Disease Control and Prevention (CDC)]] <br />
* [[U.S. Department of Commerce]] <br />
* [[Combined U.S. Department of Defense / Veterans Affairs Initiatives]] <br />
* [[U.S. Department of Defense (DoD) Initiatives]] <br />
* [[Department of Veterans Affairs Initiatives]] <br />
* [[U.S. Department of Homeland Security]] <br />
* [[Healthcare Information Technology Standards Panel (HITSP)]] <br />
* [[Purpose and overview | International perspectives]] <br />
* [[UK]] <br />
* [[National Electronic Health Record Program in United Kingdom]]<br />
* [[:Category:Blogposium|All articles resulting from the Blogposium collaboration]]<br />
* [[Maternal and Perinatal Quality Care Collaboratives]]<br />
* [[EHealth Initiative]]<br />
* [[Meaningful use]]<br />
* [[Electronic Laboratory Reporting]]<br />
* [[Department of Education]]<br />
<br />
==[[:Category:Training and User Support | Training and User Support]]==<br />
<br />
==[[:Category:Terminology and Coding | Terminology and Coding]]==<br />
* [[Glossary of acronyms]] <br />
* [[Definition and Use of Interface Terminologies]] <br />
* [[Common Terminology Services | Common Terminology Services (CTS)]]<br />
* [[Distributed Cognition and Knowledge-based Controlled Medical Terminologies]]<br />
* [[Ontology]] <br />
* [[International Statistical Classification of Diseases | International Statistical Classification of Diseases (ICD)]]<br />
* [[Systematized Nomenclature Of Medicine | Systematized Nomenclature Of Medicine (SNOMED)]] <br />
* [[International Dietetics and Nutrition Terminology | International Dietetics and Nutrition Terminology (IDNT)]]<br />
* [[International Classification of Primary Care | International Classification of Primary Care (ICPC)]]<br />
* [[Unified Medical Language System | Unified Medical Language System (UMLS)]]<br />
* [[Aggregated data]]<br />
<br />
==[[:Category:Business and Organization | Business and Organization]]==<br />
* [[The Role of the CMIO]]<br />
* [[Electronic Healthcare Communication]]<br />
* [[SMS, Blogs and the Patient-Provider Relationship: Enhancing Communication, Improving Treatment Outcomes]]<br />
* [[Vendor negotiations]]<br />
* [[Application of Project Management Concepts to Mitigate Time and Change Process Barriers to EHR Adoption]]<br />
* [[Prescriptive analytics]]<br />
<br />
==[[:Category:Workflow | Workflow]]==<br />
* [[Methods to capture workflow]] <br />
* [[Measurement]] <br />
* [[Importance of Workflow Analysis During Physician Office EMR Implementation]] <br />
* [[Workflow Management System]] <br />
* [[Process Mining]]<br />
* [[Using Evidence-Based Layout Design to Enhance Workflow in the Clinical Laboratory]]<br />
* [[Planning for Radiology CDS Technology]]<br />
<br />
==[[:Category:Interface, Usability and Accessibility | Interface, Usability and Accessibility]]==<br />
* [[Usability]] <br />
* [[Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA]]<br />
* [[Software Test Documentation]]<br />
* [[Data Model to Enhance the Security and Privacy of Healthcare Data]]<br />
<br />
=[[:Category:Reference | Reference]]=<br />
<br />
==[[:Category:Academics and Education | Academics and Education]]==<br />
* [[Informatics Students' Contributions|Contributions from OHSU students]]<br />
* [[List of Informatics Departments]]<br />
* [[Endowed Professorships | Endowed Professorships and Chairs in Health / Medical / Nursing / Biomedical Informatics]]<br />
* [[Graduate Medical Education Milestones]]<br />
<br />
==[[:Category:Specialites and Disciplines | Specialites and Disciplines]]==<br />
* [[Medical Subspecialty Board of Clinical Informatics]]<br />
* [[Clinical Informatics Fellowship]]<br />
* [[Health informatics]]<br />
* [[Nursing informatics]]<br />
* [[Imaging informatics]]<br />
* [[Consumer health informatics]]<br />
* [[Public Health Informatics]]<br />
* [[Dental informatics]]<br />
* [[Medical laboratory informatics]]<br />
* [[Quality Informatics]]<br />
* [[Bioinformatics]]<br />
* [[Translational Bioinformatics]]<br />
* [[Clinical Social Work Informatics]]<br />
* [[Pharmacy Informatics]]<br />
* [[Clinical research informatics]]<br />
* [[Traditional Chinese Medicine (TCM) informatics]]<br />
<br />
==[[:Category:Research Groups | Research Groups]]==<br />
* [[CIRCLE: Clinical Informatics Research Collaborative]]<br />
* [[Biomedical Informatics Research Network (BIRN)]]<br />
<br />
==[[:Category:Literature | Literature]]==<br />
* [[Books | Books on Topics in Clinical Informatics]]<br />
* [[Leading Health Informatics and Medical Informatics Journals]]<br />
<br />
==[[:Category:External Links | External Links]]==<br />
* [http://www.ohsu.edu/xd/ Oregon Health & Science University]<br />
* [http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/dmice/ The Department of Medical Informatics and Clinical Epidemiology at OHSU]<br />
* [http://www.cpoe.org Website of the Provider Order Entry Team from Oregon Health]<br />
* [http://hittransition.com/tools.htm Links to online tools for HIT/RHIO development]<br />
* [http://www.hitdashboard.com/unitedStates.aspx Health Information Technology Dashboard]<br />
* [http://wellness.wikispaces.com/Tactic+-+Use+Evolving+Health+Information+Technology+Tools Wellness Wiki: Use Evolving Health Information Technology Tools]<br />
* [http://www.emedicine.com/ eMedicine] Physician contributed medical articles and CME<br />
* [http://www.kmle.com KMLE Medical Dictionary] Medical dictionary and medical related links<br />
* [http://www.merckmedicus.com Merck Medicus] Contains a significant number of textbook resources (requires free registration<br />
* [http://www.nlm.nih.gov NLM] (US National Library of Medicine)<br />
* [http://www.webmd.com WebMD] General comprehensive online health information<br />
* [http://www.open.medicdrive.org Medicine 2.0] Comprehensive online Personal health record information.<br />
* [http://www.searchmedica.com SearchMedica.com] Searches medical literature for health care professionals<br />
* [http://www.ahima.org AHIMA] American Health Information Management Association<br />
* [http://www.amia.org AMIA] American Medical Informatics Association<br />
* [http://www.ania-caring.org ANIA-CARING] American Nursing Informatics Association and the Capital Area Roundtable on Informatics in NursinG<br />
* [http://www.himss.org HIMSS] Healthcare Information and Management Systems<br />
* [http://www.imia-medinfo.org IMIA] International Medical Informatics Association<br />
* [http://wellness.wikispaces.com/Tactic+-+Use+Evolving+Health+Information+Technology+Tools Use Evolving Health Information Technology Tools]<br />
* [http://wellness.wikispaces.com/Blueprint+for+an+Integrated+HIT+system+-+The+Patient+Life-Cycle+Wellness+System Blueprint for an Integrated HIT system - The Patient Life-Cycle Wellness System]<br />
* [http://circleinformatics.org CIRCLE: Clinical Informatics Research Collaborative]</div>Sgebauerhttps://clinfowiki.org/wiki/index.php/Graduate_Medical_Education_MilestonesGraduate Medical Education Milestones2015-04-23T23:27:27Z<p>Sgebauer: </p>
<hr />
<div><br />
<br />
Graduate medical education (residency and fellowship) is increasingly focusing on systems- and practice-based improvement as part of training a physician workforce that is comfortable with these concepts. The primary method of assessment currently is milestones. <br />
<br />
<br />
== '''What are milestones?''' ==<br />
<br />
Milestones are “competency-based developmental outcomes (e.g., knowledge, skills, attitudes, and performance) that can be demonstrated progressively by residents/fellows from the beginning of their education through graduation to the unsupervised practice of their specialties”1. They were developed by the American Council on Graduate Medical Education (ACGME) and incorporate six core competencies: <br />
<br />
• patient care<br />
<br />
• medical knowledge<br />
<br />
• systems-based practice<br />
<br />
• practice-based learning and improvement<br />
<br />
• professionalism<br />
<br />
• interpersonal and communications skills <br />
<br />
<br />
== '''Specialty specificity''' ==<br />
<br />
Each specialty has worked with the ACGME to develop specific milestones for each area of competency, described in 4-5 levels from novice (Level 1) to expert (Level 5).1,2 These milestones vary widely in specifics, but are all described in the same format and according to the six core competencies. <br />
<br />
For example, a Family Medicine resident at Level 4 competency for Patient Care “integrates disease prevention and health promotion seamlessly in the ongoing care of all patients”2 while an anesthesiology resident at Level 4 competency for Patient Care “conducts complex anesthetics with conditional independence; may supervise others in the management of complex clinical problems”3. Both of these competencies are crucial to their respective fields, but a family medicine resident would not be expected to conduct a complex anesthetic, and an anesthesiology resident would not be expected to integrate disease prevention into the care of all patients. However, they are both reflect a level of sophistication in medical practice within their respective fields that experts believe would be sufficient for a graduating resident.<br />
<br />
Some of the milestones, particularly in competencies such as Practice-based Learning and Improvement and Systems-based Practice, describe similar objectives in slightly different language.<br />
<br />
For example, below are Level 3 milestones within the Practice-based Learning and Improvement core competency in three distinct fields:<br />
<br />
Anesthesiology: “Identifies patient safety issues within one’s practice, and participates in quality improvement plans to address them”3<br />
<br />
Family medicine: “Uses a systematic improvement method (e.g., Plan-Do-Study-Act (PDSA) cycle) to address an identified area of improvement”2<br />
<br />
Psychiatry: “Involves appropriate stakeholders in design of a QI project”.4<br />
<br />
<br />
== '''Goals of the milestones''' ==<br />
<br />
The goals of the milestones are primarily to aid in curriculum development, program accreditation, and resident learning1. <br />
<br />
<br />
== '''Resident assessment with milestones''' ==<br />
<br />
In general, level 4 is meant to be the goal for graduating residents, though a resident does not have to reach a specific level in order to graduate. Residents are evaluated on at least a yearly basis, and the system is intended to help identify learning opportunities earlier in the resident’s career. Because the focus of milestones is on learner outcomes, the historically very tight time constraints of a residency program (generally 3-5 years depending on the specialty) or fellowship (generally 1-3 years depending on the subspecialty) could be erased. This means exceptional residents could theoretically graduate in less than the anticipated time, and that others may need to stay in residency for additional time to achieve the milestones.5 <br />
<br />
<br />
== '''Milestones and the Next Accreditation System''' ==<br />
<br />
The Next Accreditation System (NAS) is a system for the ACGME to ensure high quality of residency programs. Its goal is in part to “accelerate the ACGME’s movement toward accreditation on the basis of educational outcomes”6<br />
<br />
<br />
<br />
== '''History of milestones''' ==<br />
<br />
The ACGME was created in 1981 in response to more formal sub-specialization and a perceived lack of consistency in quality of residency education.6 The ACGME made the residency requirements more formal, but there was a perceived decrease in innovation and an increase in administrative burden.6 The six clinical competencies were introduced in 1999. Milestones data was first collected in 2012, with seven specialties including internal medicine and pediatrics being early adopters.6<br />
<br />
<br />
== '''Controversies of the milestones''' ==<br />
<br />
Some have argued that the focus on outcomes fails to capture measures that are crucial to a good physician but more difficult to measure, such as “situational awareness, empathy, leadership, and resource management”5. <br />
<br />
Others have argued that because the milestones rely on human raters that often use subjective or selective information to score the residents, “the meanings of the ratings that are combined into an overall summative judgment are highly variable”7. Some have questioned whether attending physicians’ supervision of residents is adequate to develop a well-informed opinion about a resident’s competency level7. <br />
<br />
One group attempted to identify validated evaluation tools for the competencies, but determined “the peer-reviewed literature provides no evidence that current measurement tools can assess the competencies independently of one another”8.<br />
<br />
<br />
== '''Clinical informatics and milestones''' ==<br />
<br />
The ACGME states that “patients, payers, and the public demand information-technology literacy, sensitivity to cost-effectiveness, the ability to involve patients in their own care, and the use of health information technology to improve care for individuals and populations”.6 These attributes overlap broadly with clinical informatics, which includes patient engagement in electronic health records, clinical decision support and data retrieval.9<br />
<br />
Clinical informatics impacts several of the areas of competencies included in the milestones. The most notable overlap between clinical informatics and graduate medical education is in the areas of systems-based practice and practice-based learning and improvement, as well as some aspects of professionalism. Several examples of clinical informatics-associated milestones from disparate specialties are provided below.<br />
<br />
<br />
== '''Journal articles on clinical informatics and milestones''' ==<br />
<br />
• Tierney et al identified issues with EHRs related to the core competencies10, including the use of clinical decision support (CDS), automation bias, data gathering and presentation, and computer-provider interactions. <br />
<br />
• Pageler et al suggested additions to the core competencies that incorporate EMR-related learning opportunities, such as CDS tailored to trainee knowledge gaps, and trainee-specific clinical outcome reports.11 <br />
<br />
• Hersh et al mapped clinical informatics competencies to the general competencies for an undergraduate medical education curriculum.12 <br />
<br />
<br />
== '''Related topics''' ==<br />
<br />
[[Quality Informatics]]<br />
<br />
<br />
<br />
== '''References''' ==<br />
<br />
<br />
1. Accreditation Council for Graduate Medical Education. (Accessed April 18, 2015, at https://http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.)<br />
<br />
2. The Family Medicine Milestone Project. The Accreditation Council for Graduate Medical Education and The American Board of Family Medicine. (Accessed April 18, 2015, at https://http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/FamilyMedicineMilestones.pdf.)<br />
<br />
3. The Anesthesiology Milestone Project. The Accreditation Council for Graduate Medical Education and The American Board of Anesthesiology, 2013. (Accessed April 18, 2015, at http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/AnesthesiologyMilestones.pdf.)<br />
<br />
4. The Psychiatry Milestones Project. The Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology, 2013. (Accessed April 18, 2015, at https://http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf.)<br />
<br />
5. Ebert TJ, Fox CA. Competency-based education in anesthesiology: history and challenges. Anesthesiology 2014;120:24-31.<br />
<br />
6. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system--rationale and benefits. N Engl J Med 2012;366:1051-6.<br />
<br />
7. Williams RG, Dunnington GL, Mellinger JD, Klamen DL. Placing Constraints on the Use of the ACGME Milestones: A Commentary on the Limitations of Global Performance Ratings. Acad Med 2015;90:404-7.<br />
<br />
8. Lurie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Acad Med 2009;84:301-9.<br />
<br />
9. Clinical Informatics. (Accessed April 21, 2015, at https://http://www.amia.org/applications-informatics/clinical-informatics.)<br />
<br />
10. Tierney MJ, Pageler NM, Kahana M, Pantaleoni JL, Longhurst CA. Medical education in the electronic medical record (EMR) era: benefits, challenges, and future directions. Acad Med 2013;88:748-52.<br />
<br />
11. Pageler NM, Friedman CP, Longhurst CA. Refocusing medical education in the EMR era. JAMA 2013;310:2249-50.<br />
<br />
12. Hersh WR, Gorman PN, Biagioli FE, Mohan V, Gold JA, Mejicano GC. Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education. Adv Med Educ Pract 2014;5:205-12.<br />
<br />
Submitted by Sarah Gebauer<br />
<br />
[[Category:BMI512-SPRING-15]]</div>Sgebauerhttps://clinfowiki.org/wiki/index.php/Graduate_Medical_Education_MilestonesGraduate Medical Education Milestones2015-04-23T21:13:42Z<p>Sgebauer: Graduate Medical Education Milestones and their relationship to Clinical Informatics</p>
<hr />
<div><br />
<br />
Graduate medical education (residency and fellowship) is increasingly focusing on systems- and practice-based improvement as part of training a physician workforce that is comfortable with these concepts. The primary method of assessment currently is milestones. <br />
<br />
<br />
== '''What are milestones?''' ==<br />
<br />
Milestones are “competency-based developmental outcomes (e.g., knowledge, skills, attitudes, and performance) that can be demonstrated progressively by residents/fellows from the beginning of their education through graduation to the unsupervised practice of their specialties”1. They were developed by the American Council on Graduate Medical Education (ACGME) and incorporate six core competencies: <br />
<br />
• patient care<br />
<br />
• medical knowledge<br />
<br />
• systems-based practice<br />
<br />
• practice-based learning and improvement<br />
<br />
• professionalism<br />
<br />
• interpersonal and communications skills. <br />
<br />
<br />
== '''Specialty specificity''' ==<br />
<br />
Each specialty has worked with the ACGME to develop specific milestones for each area of competency, described in 4-5 levels from novice (Level 1) to expert (Level 5).1,2 These milestones vary widely in specifics, but are all described in the same format and according to the six core competencies. <br />
<br />
Examples of Level 3 milestones within the Practice-based Learning and Improvement core competency:<br />
<br />
Anesthesiology: “Identifies patient safety issues within one’s practice, and participates in quality improvement plans to address them”3<br />
<br />
Family medicine: “Uses a systematic improvement method (e.g., Plan-Do-Study-Act (PDSA) cycle) to address an identified area of improvement”2<br />
<br />
Psychiatry “Involves appropriate stakeholders in design of a QI project”.4<br />
<br />
<br />
== '''Goals of the milestones''' ==<br />
<br />
The goals of the milestones are primarily to aid in curriculum development, program accreditation, and resident learning1. <br />
<br />
<br />
== '''Resident assessment with milestones''' ==<br />
<br />
In general, level 4 is meant to be the goal for graduating residents, though a resident does not have to reach a specific level in order to graduate. Residents are evaluated on at least a yearly basis, and the system is intended to help identify learning opportunities earlier in the resident’s career. <br />
<br />
<br />
== '''Milestones and the Next Accreditation System''' ==<br />
<br />
The Next Accreditation System (NAS) is a system for the ACGME to ensure high quality of residency programs. Its goal is in part to “accelerate the ACGME’s movement toward accreditation on the basis of educational outcomes”5<br />
<br />
<br />
<br />
== '''History of milestones''' ==<br />
<br />
The ACGME was created in 1981 in response to more formal sub-specialization and a perceived lack of consistency in quality of residency education.5 The ACGME made the residency requirements more formal, but there was a perceived decrease in innovation and an increase in administrative burden.5 The six clinical competencies were introduced in 1999. Milestones data was first collected in 2012, with seven specialties including internal medicine and pediatrics being early adopters.5<br />
<br />
<br />
== '''Clinical informatics and milestones''' ==<br />
<br />
The ACGME states that “patients, payers, and the public demand information-technology literacy, sensitivity to cost-effectiveness, the ability to involve patients in their own care, and the use of health information technology to improve care for individuals and populations”.5 These attributes overlap broadly with clinical informatics, which includes patient engagement in electronic health records, clinical decision support and data retrieval.6<br />
<br />
Clinical informatics impacts several of the areas of competencies included in the milestones. The most notable overlap between clinical informatics and graduate medical education is in the areas of systems-based practice and practice-based learning and improvement, as well as some aspects of professionalism. Several examples of clinical informatics-associated milestones from disparate specialties are provided below.<br />
<br />
<br />
== '''Journal articles on clinical informatics and milestones''' ==<br />
<br />
• Tierney et al identified issues with EHRs related to the core competencies7, including the use of clinical decision support (CDS), automation bias, data gathering and presentation, and computer-provider interactions. <br />
<br />
• Pageler et al suggested additions to the core competencies that incorporate EMR-related learning opportunities, such as CDS tailored to trainee knowledge gaps, and trainee-specific clinical outcome reports.8 <br />
<br />
• Hersh et al mapped clinical informatics competencies to the general competencies for an undergraduate medical education curriculum.9 <br />
<br />
<br />
== '''Related topics''' ==<br />
<br />
[[Quality Informatics]]<br />
<br />
[[Evidence-based medicine]]<br />
<br />
<br />
Submitted by Sarah Gebauer, MD<br />
<br />
[[Category:BMI512-SPRING-15]]<br />
<br />
1. Accreditation Council for Graduate Medical Education. (Accessed April 18, 2015, at https://http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.)<br />
2. The Family Medicine Milestone Project. The Accreditation Council for Graduate Medical Education and The American Board of Family Medicine. (Accessed April 18, 2015, at https://http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/FamilyMedicineMilestones.pdf.)<br />
3. The Anesthesiology Milestone Project. The Accreditation Council for Graduate Medical Education and The American Board of Anesthesiology, 2013. (Accessed April 18, 2015, at http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/AnesthesiologyMilestones.pdf.)<br />
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