Transforming Faculty Evaluations in the CBME Era with ACGME Clinician Educator Milestones

The assessment and evaluation of learners has been a mainstay of the Graduate Medical Education (GME) setting. However, the assessment and evaluation of faculty have yet to garner nearly as much attention. While this new era of Competency-Based Medical Education (CBME) emphasizes the learner-centric approach to residency training, it also highlights the importance of developing clinician educators (CE) who can role model the approach.

The national ACGME Resident and Faculty Surveys are validated instruments that provide one surrogate measure of CE effectiveness with a national comparator. The “Faculty Teaching and Supervision,” “Resources,” “Professionalism,” and “Evaluation” sections all have questions directly related to common CE activities.^1,2 A lack of attention to the critical function of providing faculty with adequate assessment and evaluation of their work as educators could result in relatively low levels of compliance on these surveys. In addition, there is some evidence that a lack of adequate feedback may be contributing to the levels of burnout and difficulty retaining faculty.³ As there continue to be many open residency faculty positions, this highlights the importance of developing a comprehensive and proactive faculty evaluation process.

The ACGME clinician educator milestones could be one instrument used to foster self-reflection and identify areas for improvement as a clinician educator.⁴ As we ask our residents to self-reflect to help create their Individualized Learning Plans, we should also ask the same of ourselves and our faculty members as CEs. This is an important personal and professional development practice, and it also role models that we are forever in a growth mindset and willing to strive to be “master adaptive learners.” The clinician educator milestones are “a series of sub-competencies designed to aid in the development and improvement of teaching and learning skills across the continuum of medical education.”⁴ These milestones can provide a tool for structured self-assessment for CEs and can be used as an instrument for a trusted peer to provide an external assessment. As these milestones are not (yet) an accreditation requirement, they can be used as a low-stakes opportunity for honest self-improvement and to identify targeted professional development. Five competencies have been identified:

• 1) Universal Pillars for All Clinician Educators

• 2) Educational Theory and Practice

• 3) Well-Being

• 4) Diversity, Equity, and Inclusion in the Learning Environment

• 5) Administration

The Clinician Educator Supplemental Guide provides examples of each milestone element to further assist CEs in developing their own personal improvement plan. Examples are broken down to further separate undergraduate medical education, GME, and continued professional development.⁵ To improve as a CE, one has to be open to assessment. Some suggestions for assessment include direct observation, faculty-observed structured teaching, multisource feedback from learners, learner outcomes, OSTEs, and performance assessment and review.

The Society of General Internal Medicine Education Committee published a position paper calling for the use of these milestones to help CEs create their own individualized professional development plans to promote career success.⁶ Additionally, just as the original resident milestones are an opportunity for program and institutional assessment, aggregating the milestones outcomes from CEs can provide a needs assessment to help create purposeful faculty development interventions. In family medicine, program directors could consider aggregating their core faculty CE milestones self-assessments to identify faculty development needs and to help mentor their core faculty.

Faculty development, assessment, and evaluation are essential to any successful residency program, especially with the new requirements and movement toward CBME. Using the ACGME clinician educator milestones to promote faculty professional development could provide the structure needed to help improve program performance in the “Faculty Teaching and Supervision” section of the ACGME survey. More importantly, using the CE milestones and increasing focus on faculty assessment and evaluation will likely help with faculty retention and well-being by highlighting specific elements to focus efforts in the otherwise nebulous area of faculty development.

• © 2024 Annals of Family Medicine, Inc.