Hospice and Palliative Medicine Milestones - The Accreditation Council for Graduate Medical Education - acgme
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Hospice and Palliative Medicine Milestones
The Accreditation Council for Graduate Medical Education
Second Revision: March 2019
First Revision: October 2014Hospice and Palliative Medicine Milestones
The Milestones are designed only for use in evaluation of fellows 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 fellow 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.
iiHospice and Palliative Medicine Milestones
Co-Chairs
Jillian Gustin, MD and Lindy Landzaat, DO, FAAHPM
Work Group
Michael Barnett, MD, MS, FACP, FAAP, Dale Lupu, MPH, PhD
FAAHPM Laura J. Morrison, MD, FAAHPM
Gary Buckholz, MD, HMDC, FAAHPM Tomasz Okon, MD
April Christensen, MD, MS Steven M. Radwany, MD, FACP, FAAHPM
Laura Edgar, EdD, CAE Holly Yang, MD, MSHPEd, HMDC, FACP,
Jennifer Hwang, MD, MHS FAAHPM
Catherine Bree Johnston, MD, MPH
The ACGME would like to thank the following organizations for their continued support in the development of
the Milestones:
American Board of Internal Medicine
American Academy of Hospice and Palliative Medicine
iiiUnderstanding Milestone Levels and Reporting
This document presents the Milestones, which programs use in a semi-annual review of fellow performance, and then report to
the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME Competencies organized in a
developmental framework. The narrative descriptions are targets for fellow performance throughout their educational program.
Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert
resident/fellow in the specialty or subspecialty. For each reporting period, the Clinical Competency Committee will review the
completed evaluations to select the milestone levels that best describe each learner’s current performance, abilities, and attributes
for each subcompetency.
These levels do not correspond with post-graduate year of education. Depending on previous experience, a junior fellow may
achieve higher levels early in his/her educational program just as a senior fellow may be at a lower level later in his/her
educational program. There is no predetermined timing for a resident to attain any particular level. Fellows may also regress in
achievement of their milestones. This may happen for many reasons, such as over scoring in a previous review, a disjointed
experience in a particular procedure, or a significant act by the fellow.
Selection of a level implies the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see
the diagram on page vi).
ivAdditional Notes
Level 4 is designed as a graduation goal but does not represent a graduation requirement. Making decisions about readiness for
graduation and unsupervised practice is the purview of the program director. Furthermore, Milestones 2.0 include revisions and
changes that preclude using Milestones as a sole assessment in high-stakes decisions (i.e., determination of eligibility for
certification or credentialing). Level 5 is designed to represent an expert fellow whose achievements in a subcompetency are
greater than the expectation. Milestones are primarily designed for formative, developmental purposes to support continuous
quality improvement for individual learners, education programs, and the specialty. The ACGME and its partners will continue to
evaluate and perform research on the Milestones to assess their impact and value.
Examples are provided for some milestones within this document. Please note: the examples are not the required element or
outcome; they are provided as a way to share the intent of the element.
Some milestone descriptions include statements about performing independently. These activities must occur in conformity to
ACGME supervision guidelines as described in the Program Requirements, as well as to institutional and program policies. For
example, a resident who performs a procedure independently must, at a minimum, be supervised through oversight.
A Supplemental Guide is also available to provide the intent of each subcompetency, examples for each level, assessment
methods or tools, and other available resources. The Supplemental Guide, like examples contained within the Milestones, is
designed only to assist the program director and Clinical Competency Committee, and is not meant to demonstrate any required
element or outcome.
Additional resources are available in the Milestones section of the ACGME website. Follow the links under “What We Do” at
www.acgme.org.
vThe diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME
Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be
indicated by selecting the level of milestones that best describes that fellow’s performance in relation to those milestones.
Selecting a response box in the Selecting a response box on the line in
middle of a level implies that between levels indicates that milestones
milestones in that level and in lower in lower levels have been substantially
levels have been substantially demonstrated as well as some
demonstrated. milestones in the higher level(s).
viVersion 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Patient Care 1: Comprehensive Whole Patient Assessment
Level 1 Level 2 Level 3 Level 4 Level 5
Performs a general Performs a symptom- Performs a detailed Performs a Promotes comprehensive
history and physical focused history and symptom assessment comprehensive symptom assessment
physical using developmentally symptom assessment across care teams
appropriate symptom using developmentally
assessment tools appropriate symptom
assessment tools in
collaboration with the
interdisciplinary team
Performs a general Identifies potential Performs a detailed Performs a Promotes comprehensive
psychosocial history supports and stressors for psychosocial and spiritual comprehensive psychosocial and spiritual
patients and their assessment using psychosocial and assessment across care
families/caregivers developmentally spiritual assessment teams
including psychological, appropriate assessment using developmentally
spiritual, social, tools appropriate assessment
developmental stage, tools in collaboration
financial, and cultural with the interdisciplinary
factors team
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
1Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Patient Care 2: Addressing Suffering and Distress
Level 1 Level 2 Level 3 Level 4 Level 5
Manages common Manages common Manages complex Manages refractory Manages physical
physical symptoms with physical symptoms with a physical symptoms with a symptoms across care symptoms with innovative
basic treatment options range of treatment comprehensive range of settings and advanced treatment
options treatment options options
Acknowledges Refers to interdisciplinary Collaborates with the Provides Maintains a therapeutic
psychosocial and team to address interdisciplinary team to comprehensive presence for a patient
spiritual distress psychosocial and spiritual manage psychosocial and management for with intractable suffering
distress spiritual distress complex psychosocial and assists families and
and spiritual distress in teams
collaboration with
community resources
across care settings
Identifies palliative Initiates medical Mobilizes the Consistently manages Participates in systems
emergencies management for interdisciplinary team and and provides improvement
emergencies manages an emergency anticipatory coaching opportunities to address
using comprehensive across care settings patient care emergencies
treatments consistent with
patient goals
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
2Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Patient Care 3: Withholding and/or Withdrawal of Life-Sustaining Therapies (LST)
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies distress Identifies ethical, legal, Develops a care plan Facilitates shared Promotes best practices
associated with institutional, cultural, and considering burdens and decision making; plans in withholding or
withholding or religious perspectives to benefits of withholding or for withholding or withdrawal of ANH or LST
withdrawing artificial withholding or withdrawing ANH in withdrawal of ANH; at the system level
nutrition or hydration withdrawing ANH specific clinical scenarios provides support to
(ANH) family/caregivers and
teams
Identifies distress Identifies ethical, legal, Manages withdrawal of Facilitates shared
associated with institutional, cultural, and LST and manages decision making; plans
withholding or religious perspectives to symptoms before, during, for withholding or
withdrawing LST withholding or and after withdrawal or in withdrawal of LST;
withdrawing LST lieu of withholding LST provides support to
family/caregivers and
teams
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
3Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Patient Care 4: Care of the Imminently Dying
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies signs and Identifies risk of and Manages evolving Manages distressing Promotes best practices
symptoms of imminent manages common symptoms in the context symptoms of imminent in care of the imminently
dying symptoms for the of declining organ death, including dying at the system level
imminently dying function for the complex and refractory
imminently dying symptoms, across care
settings
Identifies patients and Assesses the etiology of Provides anticipatory Provides culturally
families/caregivers in psychosocial and spiritual planning for patients, sensitive and
distress distress in patients and families/caregivers and developmentally
families/caregivers and teams appropriate
uses the interdisciplinary psychosocial and
team to provide basic spiritual support to
support distressed patients and
families/caregivers, and
identifies families at risk
for complex
bereavement
Comments:
Not Yet Completed Level 1
Not Yet Assessable
Patient Care
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
4Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Medical Knowledge 1: Disease Trajectories and Formulation of Prognosis in Serious Illness
Level 1 Level 2 Level 3 Level 4 Level 5
Recognizes common Identifies illness trajectory Identifies potential impact Integrates modifying Advances knowledge of
illness trajectories of less common disease of treatment on the illness factors on the illness application or
and recognizes trajectory trajectory including prognostication in serious
prognostic uncertainty multi-morbidity, illness
psychosocial factors,
and functional status
Identifies prognostic Identifies and describes Formulates a prognosis Facilitates consensus
formulation as a key prognostic factors, tools, by integrating prognostic on prognosis in
element for shared and models factors, tools, and collaboration with other
decision making models, recognizing care providers
limitations
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
5Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Medical Knowledge 2: Palliative Management of Pain Symptoms
Level 1 Level 2 Level 3 Level 4 Level 5
Lists commonly available Describes indications and Demonstrates knowledge Demonstrates detailed Advances knowledge
opioid and non-opioid use of opioid and non- of mechanism of action, knowledge of about pain management
analgesics opioid analgesics metabolism, adverse pharmacology of opioid for palliative patients
effects, interactions, and and non-opioid
conversions of opioid and analgesics with risks
non-opioid analgesics and benefits related to
specific patient
characteristics
Lists non-pharmacologic Describes indications of Describes locally Demonstrates
interventions for pain use of non-pharmacologic available non- evidence-based
interventions for pain pharmacologic knowledge of non-
interventions of pain pharmacologic
interventions
Lists procedural Describes indications for Describes referral criteria Demonstrates detailed
interventions for pain some procedural and for locally available knowledge of
advanced interventions to procedural and advanced appropriate procedural
address pain interventions to address and advanced
pain interventions to address
pain in specific patients
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
6Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Medical Knowledge 3: Palliative Management of Non-Pain Symptoms
Level 1 Level 2 Level 3 Level 4 Level 5
Lists commonly available Descries indications and Demonstrates knowledge Demonstrates detailed Advances knowledge
medications for non-pain use of medications for of mechanism of action, knowledge of about management for
symptoms non-pain symptoms metabolism, adverse pharmacology of non-pain symptoms for
effects, interactions, and medications for non- palliative patients
conversions (if applicable) pain symptoms with
of medications for non- risks and benefits
pain symptoms related to specific
patient characteristics
Lists non-pharmacologic Describes indications and Describes locally Demonstrates
interventions for non- use non-pharmacologic available non- evidence-based
pain symptoms interventions for non-pain pharmacologic knowledge of non-
symptoms interventions for non-pain pharmacologic
symptoms interventions for non-
pain symptoms
Lists procedural Describes indications for Describes referral criteria Demonstrates detailed
interventions for non- some procedural and for locally available knowledge of
pain symptoms advanced interventions to procedural and advanced appropriate procedural
address non-pain interventions to address and advanced
symptoms non-pain symptoms interventions to address
non-pain symptoms in
specific patients
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
7Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Medical Knowledge
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
8Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Systems-Based Practice 1: Patient Safety and Quality Improvement
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Identifies system factors Participates in analysis of Conducts analysis of Actively engages teams
knowledge of common that lead to patient safety patient safety events patient safety events and processes to modify
patient safety events events (simulated or actual) and offers error systems to prevent
prevention strategies patient safety events
(simulated or actual)
Demonstrates Reports patient safety Participates in disclosure Discloses patient safety Role models or mentors
knowledge of how to events through of patient safety events to events to patients and others in the disclosure of
report patient safety institutional reporting patients and families families (simulated or patient safety events
events systems (actual or (simulated or actual) actual)
simulated)
Demonstrates Describes local quality Participates in local Demonstrates the skills Creates, implements, and
knowledge of basic improvement initiatives quality improvement required to identify, assesses quality
quality improvement (e.g., advance directives, initiatives develop, implement, improvement initiatives at
methodologies and hospice length stay) and analyze a quality the institutional or
metrics improvement project community level
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
9Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Systems-Based Practice 2: System Navigation for Patient-Centered Care
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Coordinates care of Coordinates care of Role models effective Analyses the process of
knowledge of care patients in routine clinical patients in complex coordination of patient- care coordination and
coordination situations effectively using clinical situations centered care among leads in the design and
the roles of the effectively incorporating different disciplines and implementation of
interprofessional teams patient and family goals, specialties improvements
illness trajectory, and
available resources
Identifies key elements Performs safe and Performs safe and Role models and Improves quality of
for safe and effective effective transitions of effective transitions of advocates for safe and transitions of care within
transitions of care and care/hand-offs in routine care/hand-offs in complex effective transitions of and across health care
hand-offs clinical situations clinical situations care/hand-offs within delivery systems to
and across health care optimize patient outcomes
delivery systems,
including outpatient
settings
Demonstrates Identifies specific Uses local resources Participates in changing Leads innovations and
knowledge of population population and effectively to meet the and adapting practice to advocates for populations
and community health community health needs needs of a patient provide for the needs of and communities with
needs and disparities and inequities for the local population and specific populations health care inequities
population community
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
10Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Systems-Based Practice 3: Physician Role within Health Care Systems
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies components of Describes the physician’s Analyzes how personal Manages the Advocates for or leads
the complex health care role and how the practice affects the interrelated components change to enhance
system interrelated components system (e.g., length of of the complex health systems for patient- and
of the complex health stay, readmission rates, care systems for family-centered, high
care system impact prescribing patterns) patient- and family- value, efficient, and
patient care centered, efficient, and effective patient care
effective patient care
Describes basic health Describes payment model Uses shared decision Advocates for patient Participates in advocacy
payment systems, for serious illness (e.g., making in patient care, care, understanding the activities for health policy
including government, hospice, palliative care, taking into consideration limitations of each to better align payment
private, public, and rehab, concurrent care) payment models patient’s payment systems with high-value
uninsured care, as well model (e.g., community care
as different practice resources, patient
models assistance resources)
Describes models of Identifies resources for Describes resources for
hospice and palliative transition to independent leadership and program
care practice practice development and
effectively plans for
transition to
independent practice
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
11Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Systems-Based Practice 4: Hospice
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies the hospice Describes key domains of Demonstrates clinical Demonstrates clinical Teaches and role models
physician as having a clinical competence for competence in the role of competence in the role hospice care to non-
specific clinical role in hospice physicians hospice physician of hospice physician hospice physicians across
the hospice including interdisciplinary including interdisciplinary across all hospice settings
interdisciplinary team teamwork, management teamwork, management settings
of physical symptoms, of physical symptoms,
and use of the hospice and use of the hospice
formulary formulary, with
supervision
Identifies general Describes major Demonstrates compliance Demonstrates Advocates locally,
eligibility guidelines for regulatory requirements with regulatory compliance with regionally, or nationally
hospice care and guidelines for hospice requirements and regulatory requirements for the hospice model of
care including eligibility, guidelines for hospice and guidelines in the care
levels of care, and scope care, including role of hospice
of mandated services documentation, visits, physician across all
interdisciplinary team hospice settings
oversight, and institutional
policy implementation,
with supervision
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
12Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Systems-Based Practice
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
13Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates how to Articulates clinical Locates and applies the Critically appraises and Coaches others to
access and use available questions and elicits best available evidence, applies evidence, even critically appraise and
evidence in routine patient preferences and integrated with patient in the face of apply evidence and
patient care values in order to guide preferences and values to uncertainty and patient preferences and
evidence-based care guide patient care conflicting evidence, to values into clinical care,
guide care tailored to and/or participates in the
the individual patient developing guidelines
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
14Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Growth
Level 1 Level 2 Level 3 Level 4 Level 5
Accepts responsibility for Demonstrates openness Seeks performance data Intentionally seeks Role models consistently
personal and to performance data episodically, with performance data seeking performance
professional (feedback and other adaptability and humility consistently, with data, with adaptability and
development by input) in order to inform adaptability and humility humility
establishing goals goals
Identifies gap(s) between Analyzes and reflects on Analyzes, reflects on, and Independently analyzes, Coaches others on
expectations and actual the factors that contribute institutes behavioral reflects on, and reflective practice
performance to gap(s) between change(s) to narrow the institutes behavioral
expectations and actual gap(s) between change(s) to narrow the
performance expectations and actual gap(s) between
performance, with expectations and actual
guidance performance
Actively seeks Designs and implements Independently creates Uses performance data Facilitates the design and
opportunities to improve a learning plan, with and implements a to measure the implementation of
prompting learning plan effectiveness of the learning plans for others
learning plan and, when
necessary, improves it
Comments:
Not Yet Completed Level 1
Practice-Based Learning and Improvement
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
15Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Professionalism 1: Professional Behavior and Ethical Principles
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies and describes Takes responsibility for Demonstrates Recognizes and Coaches others when
potential triggers and own professionalism professional behavior in intervenes in situations their behavior fails to
reporting processes for lapses complex stressful that may trigger meet professional
professionalism lapses situations professionalism lapses expectations
in self and others
Demonstrates Demonstrates knowledge Analyzes and seeks help Collaborates with and Identifies and seeks to
knowledge of the ethical of the ethical principles in managing and uses appropriate address system-level
principles underlying underlying hospice and resolving complex ethical resources for managing factors that induce or
informed consent, palliative medicine issues situations and resolving ethical exacerbate ethical
surrogate decision dilemmas as needed problems or impede their
making, advance (e.g., ethics resolution
directives, confidentiality, consultations, literature
error disclosure, review, risk
stewardship of limited management/legal
resources, and related consultation)
topics
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
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16Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Professionalism 2: Accountability/Conscientiousness
Level 1 Level 2 Level 3 Level 4 Level 5
Responds promptly to Performs tasks and Performs tasks and Addresses situations Proactively implements
requests or reminders to responsibilities in a timely responsibilities in that impacts the strategies to ensure that
complete tasks and manner with appropriate collaboration with the interdisciplinary team’s the needs of patients,
responsibilities attention to detail in interdisciplinary team ability to complete tasks teams, and systems are
routine situations and responsibilities in a met
timely manner
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
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17Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Professionalism 3: Self-Awareness and Help Seeking
Level 1 Level 2 Level 3 Level 4 Level 5
Recognizes status of Independently recognizes Proposes a plan to Independently develops Coaches others when
personal and status of personal and optimize personal and a plan to optimize emotional responses or
professional well-being, professional well-being professional well-being, personal and limitations in
with assistance with assistance professional well-being knowledge/skills do not
meet professional
expectations
Recognizes limits in the Independently recognizes Receives and integrates Independently seeks,
knowledge/skills of self limits in the feedback into a plan to receives, and integrates
or team and values knowledge/skills of self or remediate or improve feedback and develops
feedback, with team and welcomes limits in the a plan to remediate or
assistance feedback knowledge/skills of self or improve limits in the
team, with assistance knowledge/skills of self
or team
Comments:
Not Yet Completed Level 1
Professionalism
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
18Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
Level 1 Level 2 Level 3 Level 4 Level 5
Uses language and non- Establishes a therapeutic Establishes a therapeutic Easily establishes Mentors others in
verbal behavior to relationship in relationship in challenging therapeutic situational awareness and
demonstrate respect and straightforward patient/family encounters relationships, with critical self-reflection to
establish rapport encounters using active attention to consistently develop
listening and clear patient/family concerns positive therapeutic
language and context, regardless relationships
of complexity
Identifies common Identifies complex Reflects on personal Consistently recognizes Mentors self-awareness
barriers to effective barriers to effective biases and modifies personal biases while practice and educates
communication (e.g., communication (e.g., approach to minimize attempting to others to use a contextual
language, disability) developmental stage, communication barriers proactively minimize approach to minimize
while accurately health literacy, cultural communication barriers communication barriers
communicating own role norms)
within the health care
system
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
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19Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Interpersonal and Communication Skills 2: Interprofessional and Team Communication
Level 1 Level 2 Level 3 Level 4 Level 5
Respectfully receives a Clearly and concisely Checks understanding of Integrates Role models flexible
consultation request responds to a recommendations when recommendations from communication strategies
consultation request providing consultation different members of that value input from all
the health care team to health care team
optimize patient care members, resolving
conflict when needed
Understands and Solicits insights from and Integrates contributions Prevents and mediates Fosters a culture of open
respects the role and uses language that values from the interdisciplinary conflict and distress communication and
function of all interdisciplinary team team members into the among the effective teamwork within
interdisciplinary team members care plan interdisciplinary team the interdisciplinary team
members members
Understands and Solicits insights from Integrates contributions Addresses conflict and Attends to individual and
respects the role and other health care teams from other health care distress among other team distress and
function of other health using language that team members into the health care team promotes resilience
care teams values all members care plan members in complex among other health care
patient situations teams
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
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educational purposes.
20Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Interpersonal and Communication Skills 3: Communication with Health Care Systems
Level 1 Level 2 Level 3 Level 4 Level 5
Accurately records Demonstrates organized Concisely reports Communicates clearly, Advocates for a systems
information in the patient diagnostic and diagnostic and concisely, in a timely approach for consistent
record therapeutic reasoning therapeutic reasoning and manner, and in an documentation of
through notes in the physician-patient organized written form, palliative care plan within
patient record communications in the including anticipatory or across care settings
patient record, including guidance
goals of care and
advance care planning
Safeguards patient Demonstrates accurate, Appropriately selects Produces written or Guides departmental or
personal health timely, and appropriate direct (e.g., telephone, in- verbal communication institutional
information use of documentation person) and indirect (e.g., (e.g., patient notes, e- communication around
shortcuts progress notes, text mail, etc.) that serves policies and procedures
messages) forms of as an example for
communication based on others to follow
context
Communicates through Documents required data Uses appropriate Collaborates with the Facilitates dialogue
appropriate channels as in formats specified by channels to offer clear interdisciplinary team to regarding systems issues
required by institution institutional policy and constructive initiate difficult among larger community
policy (e.g., patient suggestions to improve conversations with stakeholders (e.g.,
safety reports, cell the system appropriate institution, health care
phone/pager usage) stakeholders to improve system, field)
the system
Comments:
Not Yet Completed Level 1
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
21Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Interpersonal and Communication Skills 4: Complex Communication Around Serious Illness
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies prognostic Assesses the patient’s Delivers basic prognostic Tailors communication Coaches others in the
communication as a key families/caregivers’ information and attends to of prognosis according communication of
element for shared prognostic awareness emotional responses of to disease prognostic information
decision making and identifies preferences patient and characteristics and
for receiving prognostic families/caregivers trajectory, patient
information consent, family needs,
and medical
uncertainty, and is able
to address intense
emotional response
Identifies the need to Facilitates communication Sensitively and Independently uses Coaches shared decision
assess patient/family with patient/family by compassionately delivers shared decision making making in patient/family
expectations and introducing stakeholders, medical information; to align patient/family communication
understanding of their setting the agenda, elicits patient/family values, goals, and
health status and clarifying expectations, values, goals and preferences with
preferences; and treatment options to
treatment options and verifying an
acknowledges uncertainty make a personalized
understanding of the care plan in situations
and conflict, with
clinical situation guidance with a high degree of
uncertainty and conflict
Comments:
Not Yet Completed Level 1
Interpersonal and Communication Skills
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
22Version 2 Hospice and Palliative Medicine, ACGME Report Worksheet
Overall Clinical Competence
This rating represents the assessment of the fellow's development of overall clinical competence during this year of training:
____ Superior: Far exceeds the expected level of development for this year of training
____ Satisfactory: Always meets and occasionally exceeds the expected level of development for this year of training
____ Conditional on Improvement: Meets some developmental milestones but occasionally falls short of the expected level of development for
this year of training. An improvement plan is in place to facilitate achievement of competence appropriate to the level of training.
____ Unsatisfactory: Consistently falls short of the expected level of development for this year of training.
*Only required for Internal Medicine based programs
©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Hospice and Palliative Care Medicine Milestones on a non-exclusive basis for
educational purposes.
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