Neuroradiology Milestones - The Accreditation Council for Graduate Medical Education - ACGME
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Neuroradiology Milestones
The Accreditation Council for Graduate Medical Education
Implementation Date: July 1, 2021
Second Revision: May 2021
First Revision: February 2014
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
purposes.Neuroradiology 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 competence 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.
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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iiNeuroradiology Milestones Work Group
Jim C. Anderson, MD
Alok A. Bhatt, MD
Laura Edgar, EdD, CAE
Michael Keleher, DO, FAOCR
Tabassum Kennedy, MD
Robert M. Kurtz, MD
Michelle Miller-Thomas
Pamela W. Schaefer, MD, FACR
Karl A. Soderlund, MD
Christopher P. Wood, MD
The ACGME would like to thank the following organizations for their continued support in the
development of the Milestones:
American Board of Radiology
American Osteopathic Association
American Society of Neuroradiology
Review Committee for Radiology
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
purposes.
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 resident/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 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).
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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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.
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 fellow 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.
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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vThe diagram below presents an example set of milestones for one subcompetency in the same format as the ACGME
Report Worksheet. For each reporting period, a fellow’s performance on the milestones for each subcompetency 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).
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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viVersion 2 Neuroradiology, ACGME Report Worksheet
Patient Care 1: Reporting
Level 1 Level 2 Level 3 Level 4 Level 5
Generates reports with Efficiently generates Efficiently generates Generates tailored Creates and revises
appropriate elements for clear, concise, and clear, concise, and reports meeting the templates to meet the
coding thoroughly proofread thoroughly proofread needs of the needs of the subspecialty
reports which do not reports which rarely subspecialty care care provider
require substantive require correction provider
correction
Describes lexicons and Uses lexicons and Uses lexicons and Proficiently uses Serves as a role model
structured reporting structured reporting that structured reporting which lexicons and structured for use of lexicons and
do not require substantive rarely require correction reporting to provide structured reporting
correction accurate and timely
reports which do not
require correction
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
purposes.
1Version 2 Neuroradiology, ACGME Report Worksheet
Patient Care 2: Consultant in Neuroradiology
Level 1 Level 2 Level 3 Level 4 Level 5
Uses established Integrates clinical data Integrates clinical data Effectively provides Serves as an expert
evidence-based imaging with imaging findings to with imaging findings to independent neuroradiology resource
guidelines, such as develop a differential develop a differential consultation to for other providers
American College of diagnosis; uses evidence- diagnosis; uses evidence- subspecialists taking
Radiology (ACR) based imaging guidelines based imaging guidelines into consideration cost
Appropriateness to recommend imaging of to recommend imaging of effectiveness, risks, and
Criteria® common neuroradiology complex neuroradiology benefits
conditions conditions
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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2Version 2 Neuroradiology, ACGME Report Worksheet
Patient Care 3: Interpretation of Neuroimaging
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies primary Identifies secondary Prioritizes differential Provides an accurate Demonstrates expertise
imaging findings in imaging findings, diagnoses and helps to diagnosis with at a level expected of a
common conditions recognizes critical guide management integration of clinical subspecialist, including
imaging findings, and history for rare or unusual
formulates differential conditions
diagnoses
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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3Version 2 Neuroradiology, ACGME Report Worksheet
Patient Care 4: Competence in Neuroradiology Procedures
Level 1 Level 2 Level 3 Level 4 Level 5
Performs pre-procedural Competently performs Competently performs Competently performs Competently teaches
work-up procedures, with direct procedures, with indirect procedures procedural skills to others
supervision supervision independently independently
Discusses indications, Recognizes complications Manages complications, Anticipates challenges Modifies procedures in
contraindications, and and enlists help with supervision and independently anticipation of potential
potential complications manages complications challenges or
complications
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
purposes.
4Version 2 Neuroradiology, ACGME Report Worksheet
Medical Knowledge 1: Application of Neuroscience to Neuroradiology
Level 1 Level 2 Level 3 Level 4 Level 5
Discusses basic Applies knowledge of Applies knowledge of Applies knowledge of Teaches and advances
pathophysiology, pathophysiology, pathophysiology, pathophysiology, the application of
anatomy, genetics of anatomy, genetics of anatomy, genetics of anatomy, genetics of neuroscience to
diseases, and treatment- diseases, and treatment- diseases, and treatment- diseases, and neuroradiology
related effects of the related effects to image related effects to image treatment-related
brain, neck, and spine interpretation and interpretation and effects to image
management of common management of interpretation and
conditions
uncommon conditions management of rare or
unusual conditions
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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5Version 2 Neuroradiology, ACGME Report Worksheet
Medical Knowledge 2: Protocol Selection, Contrast Agent Selection/Dosing, and Image Optimization
Level 1 Level 2 Level 3 Level 4 Level 5
Discusses protocols and Selects protocols and Selects protocols and Independently tailors Teaches and/or develops
contrast agent/dose contrast agent/dose for contrast agent/dose for protocols to answer imaging protocols
common exams advanced exams complex clinical
questions
Discusses imaging Demonstrates knowledge Applies knowledge of Proficiently optimizes Teaches and advances
technology and image of image acquisition and image acquisition and image acquisition and knowledge of image
acquisition processing, and processing and processing in acquisition and
recognizes common troubleshoots for imaging collaboration with the processing
imaging artifacts and artifacts and technical technologist/imaging
technical problems problems team
Comments:
Not Yet Completed Level 1
Not Yet Assessable
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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6Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 1: Patient Safety
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 Serves as a role model to
knowledge of how to events through of patient safety events to events to patients and or mentors others in the
report patient safety institutional reporting patients and families families (simulated or disclosure of patient
events systems (simulated or (simulated or actual) actual) safety events
actual)
Comments:
Not Yet Completed Level 1
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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7Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 2: Quality Improvement
Level 1 Level 2 Level 3 Level 4 Level 5
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 initiatives develop, implement, improvement initiatives at
methodologies and and analyze a quality the divisional,
metrics improvement project departmental, or
institutional level
Comments:
Not Yet Completed Level 1
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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8Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 3: 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 Analyzes the process of
knowledge of care patients and transitions of patients and transitions of coordination of patient- care coordination or
coordination and care in routine care in complex centered care and transitions of care and
transitions of care in imaging/procedures imaging/procedures transitions of care leads in the design and
imaging/procedures among different implementation of
disciplines and multidisciplinary process
specialties improvements
Comments:
Not Yet Completed Level 1
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All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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9Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 4: Physician Role in Health Care Systems
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies key Describes how Discusses how individual Manages various Advocates for or leads
components of the components of a complex practice affects the components of the systems change that
complex health care health care system are broader system (e.g., complex health care enhances high-value,
system (e.g., hospital, interrelated, and how this length of stay, system to provide efficient, and effective
finance, personnel, impacts patient care readmission rates, clinical efficient and effective patient care
technology) efficiency) patient care
Describes the States relative cost of Describes the technical Describes the radiology Participates in health
mechanisms for common procedures and professional revenue cycle and policy revenue and
reimbursement, including components of imaging measurements of finance activities
types of payors costs productivity (e.g.,
relative value units)
Comments:
Not Yet Completed Level 1
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Neuroradiology Milestones on a non-exclusive basis for educational
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10Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 5: Contrast Agent Safety
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Recognizes contrast Manages contrast safety Independently manages Serves as a role model
knowledge of contrast safety issues and concerns and reactions, contrast safety and researches on or
safety and reactions reactions with supervision concerns and reactions teaches contrast safety,
including to referring
providers
Comments:
Not Yet Completed Level 1
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11Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 6: Radiation Safety
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Accesses resources to Communicates the Applies principles of Creates, implements, and
knowledge of the determine exam-specific relative risk of exam- ALARA in daily practice assesses radiation safety
mechanisms of radiation average radiation dose specific radiation including for pediatric initiatives at the divisional,
injury and the ALARA information exposure to patients and patients departmental, or
(“as low as reasonably practitioners institutional level
achievable”) concept
Comments:
Not Yet Completed Level 1
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12Version 2 Neuroradiology, ACGME Report Worksheet
Systems-Based Practice 7: Magnetic Resonance (MR) Safety
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Accesses resources to Discusses MR safety Independently applies Creates, implements, and
knowledge of the risks of determine the safety of concerns, including principles of MR safety assesses MR safety
magnetic resonance implanted devices and implants and retained to daily practice initiatives at the divisional,
imaging (MRI), including retained foreign bodies foreign bodies, with departmental, or
safety zones and pre- patients and practitioners institutional level
magnetic resonance
(MR) screening
Comments:
Not Yet Completed Level 1
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13Version 2 Neuroradiology, 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 Coaches others to
access and use available questions and elicits best available evidence, conflicting evidence to critically appraise and
evidence to determine patient preferences and integrated with patient guide care, tailored to apply evidence for
the best imaging values in order to guide preferences and values, the individual patient complex patients; and/or
examination for a routine evidence-based imaging to the care of complex participates in the
patient/diagnosis patients development of evidence-
based care guidelines
Comments:
Not Yet Completed Level 1
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14Version 2 Neuroradiology, ACGME Report Worksheet
Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Professional Growth
Level 1 Level 2 Level 3 Level 4 Level 5
Accepts responsibility for Receptive to performance Episodically seeks Consistently seeks Coaches other learners to
professional data and feedback in performance data and performance data and consistently seek
development by order to adjust goals feedback, with humility feedback with humility performance data and
establishing goals and adaptability and adaptability feedback
Identifies factors that Analyzes and reflects on Institutes behavioral Analyzes effectiveness Coaches others on self-
contribute to gap(s) factors that contribute to change(s) to narrow the of behavioral changes assessment and effective
between expectations gap(s) between gap(s) between where appropriate and behavioral changes
and actual performance expectations and actual expectations and actual considers alternatives in
performance performance narrowing the gap(s)
between expectations
and actual performance
Actively seeks Designs and implements Designs and implements Uses performance data Facilitates the design and
opportunities to improve a learning plan, with a learning plan to measure the implementation of
performance prompting independently effectiveness of the learning plans for others
learning plan and, when
necessary, improves it
Comments:
Not Yet Completed Level 1
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15Version 2 Neuroradiology, ACGME Report Worksheet
Professionalism 1: Professional Behavior and Ethical Principles
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Demonstrates insight into Demonstrates Recognizes situations Engages in professional
knowledge of professional behavior in professional behavior in that may trigger development educational
expectations for routine situations and complex or stressful professionalism lapses activities or coaches
professional behavior takes responsibility for situations and intervenes to others when their
and describes how to own professionalism prevent lapses in self behavior fails to meet
appropriately report lapses and others professional expectations
professional lapses
Demonstrates Analyzes straightforward Recognizes need to seek Recognizes and uses Identifies and seeks to
knowledge of the ethical situations using ethical help in managing and appropriate resources address system-level
principles underlying principles resolving complex ethical for managing and factors that induce or
informed consent, situations resolving ethical exacerbate ethical
surrogate decision dilemmas as needed problems or impede their
making, advance resolution
directives, confidentiality,
error disclosure, and
stewardship of limited
resources
Comments:
Not Yet Completed Level 1
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16Version 2 Neuroradiology, 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 Recognizes and raises Coaches and educates on
requests or reminders to responsibilities in a timely responsibilities in a timely awareness of situations professional
complete tasks and manner to ensure that the manner to ensure that the that may impact others’ accountability and
responsibilities needs of patients, teams, needs of patients, teams, ability to complete tasks managing performance
and systems are met in and systems are met in and responsibilities in a gaps
routine situations complex or stressful timely manner
situations
Comments:
Not Yet Completed Level 1
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17Version 2 Neuroradiology, 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 With assistance, Independently develops Engages in professional
personal and status of personal and proposes a plan to or modifies a plan to well-being educational
professional well-being, professional well-being optimize personal and optimize personal and activities or coaches
with assistance, and is using available resources professional well-being professional well-being others to optimize
aware of available when appropriate personal and professional
resources well-being
Recognizes limits in the Independently recognizes With assistance, Independently develops Coaches and guides
knowledge/skills of self limits in the proposes a plan to a plan to remediate or others when their
or team, with assistance knowledge/skills of self or remediate or improve improve limits in the emotional responses or
team and demonstrates limits in the knowledge/ knowledge/skills of self limitations in
appropriate help-seeking skills of self or team or team knowledge/skills do not
behaviors meet professional
expectations
Comments:
Not Yet Completed Level 1
This subcompetency is not intended to evaluate a fellow’s well-being. Rather, the intent is to ensure that each fellow has the fundamental knowledge of
factors that impact well-being, the mechanism by which those factors impact well-being, and available resources and tools to improve well-being.
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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18Version 2 Neuroradiology, ACGME Report Worksheet
Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
Level 1 Level 2 Level 3 Level 4 Level 5
Accurately Identifies barriers to Identifies biases that Actively improves Coaches other learners to
communicates own role effective communication hinder effective communication barriers improve communication
within the health care (e.g., language, health communication barriers
system literacy, cultural)
Identifies the need to Organizes and initiates With guidance, sensitively Independently, uses Coaches or teaches other
adjust communication communication with and compassionately shared decision making learners in shared
strategies based on patient/family by clarifying delivers medical to align patient goals, decision making
assessment of expectations and verifying information, elicits patient and preferences with
patient/family understanding of the goals and preferences, treatment options to
expectations and clinical situation and acknowledges make a personalized
understanding of their uncertainty and conflict care plan
health status and
treatment options
Comments:
Not Yet Completed Level 1
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19Version 2 Neuroradiology, 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 Coordinates 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
Demonstrates Communicates emergent Communicates non- Communicates findings Coaches and teaches
knowledge of the findings according to emergent findings where and management other learners in tailored
institutional and national institutional or national failure to act may options (as appropriate) communications to
communication guidelines adversely affect patient that are tailored to the referring providers
guidelines outcome referring provider
Comments:
Not Yet Completed Level 1
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20Version 2 Neuroradiology, ACGME Report Worksheet
Interpersonal and Communication Skills 3: Communication within Health Care Systems
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Communicates Communicates systems Communicates clear Facilitates dialogue
knowledge of institutional appropriately as required concerns in a respectful and constructive regarding systems issues
communications policies, by institutional policy manner suggestions to improve among larger community
including the systems stakeholders (division,
safeguarding patient department, institution,
information health care system)
Comments:
Not Yet Completed Level 1
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