When Does a House Officer Become an Internist?
A brief primer on the Next Accreditation System (NAS).
Entrustable Professional Activities (EPAs)
Attributes expected of an Internist in independent practice.
EPAs are a set of basic expectations that must be met by a graduating resident to practice independently (i.e., become an Internist). These standards have been developed by AAIM (Academic Alliance of Internal Medicine) and ABIM (American Board of Internal Medicine). Residency education is, thus, designed to ensure these EPAs are met by graduation. While it is not necessary that an individual rotation incorporate experiences to support every EPA, the sum experience of all rotations during residency must.
Curricular Milestones (CMs)
Level-appropriate expectations that define what it means to be a competent Internist.
To demonstrate a graduating resident has met the EPAs, criteria have been developed by AAIM and ABIM for each EPA that should be evaluated and met at expected times during a resident's training; these interval-based criteria are termed Curricular Milestones and are Competency-based. Advancement in training requires meeting appropriately timed milestones; failure to do so will result in the extension or termination of training.
The level appropriate expectations are as follows:
Competencies
Categories that define what is required to train one to become an Internist.
The Curricular Milestones have been developed based on the ACGME-mandated six (6) core competencies:
- Patient Care (PC)
- Medical Knowledge (MK)
- Practice-Based Learning and Improvement (PBLI)
- Interpersonal and Communication Skills (ICS)
- Professionalism (P)
- Systems-Based Practice (SBP)
Putting It All Together
An example:
Letters designate the milestone within the competency.
Numbers designate the interval by which the milestone should be met.
