ACGME Accreditation Council for Graduate Medical Education


When the ACGME made the move to continuous accreditation, specialty groups worked together to develop outcomes-based Milestones as a framework for determining resident and fellow performance within the six ACGME Core Competencies.

What are Milestones?
Simply defined, a milestone is a significant point in development. The Milestones are competency-based developmental outcomes (e.g., knowledge, skills, attitudes, and performance) that can be demonstrated progressively by residents and fellows from the beginning of their education through graduation to the unsupervised practice of their specialties.

The Milestones are designed only for use in evaluation of resident physicians in the context of their participation in ACGME-accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of the resident or fellow physician in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context.

Who developed the Milestones?
Each specialty’s Milestones Working Group was co-convened by the ACGME and relevant American Board of Medical Specialties (ABMS) specialty board(s), and was composed of ABMS specialty board representatives, program director association members, specialty college members, ACGME Review Committee members, residents, fellows, and others.

Why Milestones?
First and foremost, the Milestones are designed to help all residencies and fellowships produce highly competent physicians to meet the health and health care needs of the public. To this end:

The Milestones serve important purposes in program accreditation by:

      • Allowing for continuous monitoring of programs and lengthening of site visit cycles
      • Providing Public Accountability – report at a national level on aggregate competency outcomes by specialty
      • Establishing a community of practice for evaluation and research, with focus on continuous improvement of graduate medical education (GME)

For educational (residency/fellowship) programs, the Milestones:

      • Provide a rich, descriptive, developmental framework for Clinical Competency Committees (CCCs)
      • Guide curriculum development
      • Support better assessment practices
      • Enhance opportunities for early identification of struggling residents and fellows

For residents and fellows, the Milestones:

      • Provide more explicit and transparent expectations of performance
      • Support better self-directed assessment and learning
      • Facilitate better feedback for professional development

How are the Milestones used by the ACGME?
Resident/fellow performance on the Milestones provides a source of specialty-specific data for each specialty Review Committees to use in assessing the quality of residency and fellowship programs nationally, and for programs to use in facilitating improvements to curricula and resident performance if and when needed. The Milestones are also used by the ACGME to demonstrate accountability of the effectiveness of GME within ACGME-accredited programs in meeting the needs of the public.

Feedback and Questions
We welcome your feedback and encourage you to check this section of the website periodically. We will continue to provide updated information and additional resources to help programs with their Milestones implementation.

Questions regarding Milestones development should be directed to

Milestones Staff
Eric S. Holmboe MD
Senior Vice President, Milestone Development and Evaluation

Laura Edgar EdD, CAE
Executive Director, Milestones Development

Stanley Hamstra, PhD
Vice President, Milestone Research and Evaluation


Mid-Year Milestones Reporting Window is November 2, 2015 – January 8, 2016.