LAUSR

OBJECTIVE This study aims to investigate at-risk scores of semiannual Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings for vascular surgical trainees' final achievement of competency targets. SUMMARY BACKGROUND DATA ACGME Milestones assessments have been collected since 2015 for Vascular Surgery. It is unclear whether milestone ratings throughout training predict achievement of recommended performance targets upon graduation. METHODS National ACGME Milestones data were utilized for analyses. All trainees completing 2-year vascular surgery fellowships in June 2018 and 5-year integrated vascular surgery residencies in June 2019 were included. A generalized estimating equations model was used to obtain at-risk scores for each of the 31 sub-competencies by semiannual review periods, to estimate the probability of trainees achieving the recommended graduation target based on their previous ratings. RESULTS 122 VSFs (95.3%) and 52 IVSRs (100%) were included. VSFs and IVSRs did not achieve level 4.0 competency targets at a rate of 1.6-25.4% across sub-competencies, which was not significantly different between the two groups for any of the sub-competencies (p=0.161-0.999). Trainees were found to be at greater risk of not achieving competency targets when lower milestone ratings were assigned, and at later time-points in training. At a milestone rating of ≤ 2.5, with one year remaining prior to graduation, the at-risk score for not achieving the target level 4.0 milestone ranged from 2.9% - 77.9% for VSFs and 33.3% - 75.0% for IVSRs. CONCLUSIONS The ACGME Milestones provide early diagnostic and predictive information for vascular surgery trainees' achievement of competence at completion of training.