Pathology Milestones The Accreditation Council for Graduate Medical Education - Second Revision: February 2019 First Revision: September 2013 - acgme

 
Pathology Milestones The Accreditation Council for Graduate Medical Education - Second Revision: February 2019 First Revision: September 2013 - acgme
Pathology Milestones
The Accreditation Council for Graduate Medical Education

               Second Revision: February 2019
               First Revision: September 2013
Pathology Milestones

The Milestones are designed only for use in evaluation of resident in the context of their participation in ACGME-
accredited residency programs. The Milestones provide a framework for the assessment of the development of the
resident 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.

                                                                                                                     i
Pathology Milestones

                                                            Work Group
                    Scott Anderson, MD                                                     Elaine Keung, MD, MPH
                     Adam Booth, MD                                                          Janna Neltner, MD
         Barbara Castleberry, MT(ASCP), PhD                                                 Gary Procop, MD, MS
                  Laura Edgar, EdD, CAE                                                     Alan Shienbaum, DO
                    Melissa George, DO                                                       James Stubbs, MD
                    Kate Hatlak, MSEd                                                   Charles Timmons, MD, PhD
               Andrew Hoofnagle, MD, PhD                                                     Laura Warmke, MD
                    Kathleen Jones, MD                                                       Allecia Wilson, MD
                   Karen Kaul, MD, PhD

The ACGME would like to thank the following organizations for their continued support in the development of the Milestones:

                                                      American Board of Pathology

                                              Program Directors Section (PRODS) of APC

                                                 ACGME Pathology Review Committee

                                        American Association of Colleges of Osteopathic Medicine

                                                Association of American Medical Colleges

                                              Resident Forum Executive Committee - CAP

                                                                                                                              ii
Understanding Milestone Levels and Reporting

This document presents the Milestones, which programs use in a semi-annual review of resident 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 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 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 resident may achieve
higher levels early in his/her educational program just as a senior resident 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. Residents 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 resident.

Selection of a level implies the resident substantially demonstrates the milestones in that level, as well as those in lower levels (see the
diagram on page v).

                                                                                                                                           iii
Additional 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 resident 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.

                                                                                                                                         iv
The 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 resident’s performance on the milestones for each sub-competency will be indicated by
selecting the level of milestones that best describes that resident’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).

                                                                                                                                v
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Patient Care 1: Reporting (Anatomic Pathology/Clinical Pathology [AP/CP])

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Identifies the key                Generates a timely report           Generates a timely report          Independently                    Independently generates
 elements of a report and          for a simple case, with             that includes synoptic             generates timely                 a nuanced report that
 demonstrates                      assistance                          templates and/or ancillary         integrated reports for           expresses the ambiguity
 understanding of timely                                               testing for a complex              complex cases                    and uncertainty for a
 reporting                                                             case, with assistance;                                              complex case
                                                                       independently generates
                                                                       reports for a simple case

                                                                       Generates an                       Generates an
                                                                       amended/addended                   amended/addended
                                                                       report that includes               report and documents
                                                                       updated information, with          communication with the
                                                                       assistance                         clinical team, as
                                                                                                          appropriate

 Identifies the importance         Identifies implications of          Generates a report that            Independently
 of a complete pathology           the diagnosis in the report         includes the language of           generates a report that
 report for optimal patient        and makes simple                    uncertainty, as                    includes the language
 care                              recommendations                     appropriate, with                  of uncertainty and
                                                                       assistance                         complex
                                                                                                          recommendations

 Comments:
                                                                                                                              Not Yet Completed Level 1
                                                                                                                               Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
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Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Patient Care 2: Grossing (AP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Identifies the importance         Samples and documents               Triages, samples, and              Independently triages,           Applies innovative
 of grossing and uses              simple cases, with                  documents complex                  samples, and                     approaches of grossing to
 appropriate resources             assistance                          cases, with assistance;            documents complex                demonstrate optimal
                                                                       independently triages,             cases                            pathology in unique
                                                                       samples, and documents                                              specimens
                                                                       simple cases

 Maintains specimen                Identifies specimen                 Resolves specimen                  Independently resolves           Serves as an expert for
 integrity to avoid sample         integrity issues (e.g.,             integrity issues, with             specimen integrity               gross examination
 misidentification                 fixation, floaters, clinical-       assistance                         issues, as needed
                                   pathologic correlation with
                                   operating room reports)

 Identifies the need for           Needs assistance to                 Handles assigned                   Efficiently finishes own
 time management                   handle workload                     workload with minimal to           workload and assists
                                                                       no assistance                      others as needed

 Comments:
                                                                                                                              Not Yet Completed Level 1
                                                                                                                              Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                       2
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Patient Care 3: Clinical Consultation, including On-Call Interactions (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Describes the utility of a        For simple consultations,           For complex                        Manages complex                  Recognized as an expert
 consultation and lists            delineates the clinical             consultations, delineates          consultations                    in providing
 available resources               question, obtains                   the clinical question,             independently                    comprehensive
 useful in consultation            appropriate additional              obtains appropriate                                                 consultations
                                   clinical information,               additional clinical
                                   accesses available                  information, applies
                                   resources, recommends               relevant resources, and
                                   next steps, and                     recommends next steps
                                   documents appropriately             with assistance; manages
                                   with assistance                     simple consultations
                                                                       independently

 Comments:
                                                                                                                              Not Yet Completed Level 1
                                                                                                                              Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                     3
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

Patient Care 4: Interpretation and Diagnosis (AP/CP)

Level 1                            Level 2                             Level 3                            Level 4                          Level 5
Discusses importance of            Identifies pertinent test           Consistently integrates            Makes accurate                   Is an expert diagnostician
diagnoses and test results         results and correlates to           test results with clinical         diagnoses and
in patient care                    clinical findings to develop        findings to refine                 interpretations of test
                                   a differential diagnosis            differential and propose a         results
                                                                       diagnosis

Identifies normal states           Distinguishes normal from           Identifies confounding             Gives consideration to
and reference ranges               abnormal findings                   factors, artifacts, and pre-       confounding factors in
                                                                       analytic issues                    formulating an
                                                                                                          interpretation(s) and
                                                                                                          diagnoses

Describes indications for          Proposes appropriate                Proposes and interprets            Recommends further               Proposes optimal
common tests                       initial tests                       ancillary tests in clinical        work-up using                    diagnostic and
                                                                       context                            diagnostic algorithms            therapeutic strategies
                                                                                                          and recommends                   based on patterns within
                                                                                                          therapeutic options, as          a population
                                                                                                          appropriate

Comments:
                                                                                                                         Not Yet Completed Level 1
                                                                                                                         Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        4
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Patient Care 5: Intra-Operative Consultation (IOC), including Frozen Section (FS) (AP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Describes appropriate             Assesses requests for               For complex cases,                 For complex cases,               Expertly manages all IOC
 channels for                      simple IOC and plans                addresses requests for             independently manages
 communication                     workflow, with assistance           IOC with assistance;               and addresses requests
 regarding IOC                                                         independently assesses             for IOC
                                                                       and manages requests for
                                                                       simple IOC and plans
                                                                       workflow

 Discusses specimen-               Procures tissue for                 Procures tissue for                Supervises junior
 dependent variability in          diagnosis and prepares              diagnosis and prepares             residents and advises
 approach to IOC                   quality slides on simple            quality slides for complex         technical staff members
                                   specimens, with                     specimens with                     in the performance of
                                   assistance                          assistance and                     IOC
                                                                       independently for simple
                                                                       specimens

 Demonstrates                      Identifies broad diagnostic         Interprets and                     Independently interprets
 understanding of utility of       categories (i.e., benign            communicates routine               and communicates
 IOC                               versus malignant, normal            IOC/FS and correlates              IOC/FS and correlates
                                   versus abnormal) in                 with final diagnosis, with         with final diagnosis in
                                   routine IOC                         assistance                         routine cases and in
                                                                                                          some complex cases

 Comments:
                                                                                                                             Not Yet Completed Level 1
                                                                                                                             Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                      5
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Patient Care 6: Autopsy (AP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Describes the value of            Plans and performs all              Plans and performs all             Independently plans              Uses advanced skills and
 an autopsy                        aspects of routine                  aspects of complex                 and performs all                 non-routine approaches
                                   autopsies, with assistance          autopsies, with assistance         aspects of complex               to unique autopsies
                                                                                                          autopsies in a timely
                                                                                                          manner

 Reviews clinical records          Generates preliminary               Independently generates            Independently                    Uses autopsy data to
 and concisely presents            anatomic diagnosis within           final report with                  generates final report           identify patterns that
 clinical data and history;        accepted turnaround time            clinicopathologic                  with clinicopathologic           advance medical
 communicates with                                                     correlations on routine            correlations on routine          knowledge and improve
 clinical team                                                         autopsies; with                    and complex autopsies            patient care
                                                                       assistance, generates
                                                                       final report with
                                                                       clinicopathologic
                                                                       correlations on complex
                                                                       autopsies

 Properly identifies the           Adheres to regulations              Independently adheres to           Instructs junior level
 decedent and verifies             with guidance, such as              regulations                        residents about
 consent and limitations           legal jurisdiction, statutes                                           regulations
 to extent of the autopsy          regarding device reporting
                                   and communicable
                                   diseases

 Comments:
                                                                                                                              Not Yet Completed Level 1
                                                                                                                              Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
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Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Medical Knowledge 1: Diagnostic Knowledge (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates basic                Applies anatomic, cellular,         Applies advanced                   Integrates advanced              Recognized as an expert
 medical knowledge of              and molecular knowledge             knowledge of anatomic,             knowledge of anatomic,           in the integration of
 anatomy, cellular, and            to identify pathologic              cellular, and molecular            cellular, and molecular          anatomic, cellular, and
 molecular systems                 processes                           pathology to common                pathology to common              molecular pathology
                                                                       diagnoses                          and uncommon                     knowledge to disease
                                                                                                          diagnoses
 Demonstrates                      Identifies abnormal
 knowledge of normal               histology and cell biology
 histology and cell biology

 Comments:
                                                                                                                               Not Yet Completed Level 1
                                                                                                                               Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                     7
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Medical Knowledge 2: Clinical Reasoning (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates a basic              Demonstrates clinical               Synthesizes information            Independently                     Demonstrates intuitive
 framework for clinical            reasoning to determine              to inform clinical                 synthesizes information           approach to clinical
 reasoning                         relevant information                reasoning, with                    to inform clinical                reasoning for complex
                                                                       assistance                         reasoning in complex              cases
                                                                                                          cases

 Identifies appropriate            Selects relevant                    Seeks and integrates               Independently seeks
 resources to inform               resources based on                  evidence-based                     out, analyzes, and
 clinical reasoning                scenario to inform                  information to inform              applies relevant original
                                   decisions                           diagnostic decision                research to diagnostic
                                                                       making in complex cases,           decision making in
                                                                       with assistance                    complex clinical cases

 Comments:
                                                                                                                         Not Yet Completed Level 1
                                                                                                                         Not Yet Rotated

©2019 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                     8
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Systems-Based Practice 1: Patient Safety and Quality Improvement (QI) (AP/CP)

 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 clinicians             others in the disclosure of
 report patient safety             institutional reporting             clinicians and/or patients         and/or patients and              patient safety events
 events                            systems (simulated or               and families, as                   families, as appropriate
                                   actual)                             appropriate (simulated or          (simulated or actual)
                                                                       actual)

 Demonstrates                      Describes departmental              Participates in                    Demonstrates the skills          Creates, implements, and
 knowledge of basic QI             and institutional QI                departmental and                   required to identify,            assesses QI initiatives at
 methodologies and                 initiatives                         institutional QI initiatives       develop, implement,              the institutional or
 metrics                                                                                                  and analyze a QI                 community level
                                                                                                          project

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                         9
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Systems-Based Practice 2: Systems Navigation for Patient-Centered Care (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates                      Coordinates care of                 Coordinates care of                Models effective                 Analyses the process of
 knowledge of case                 patients in routine cases           patients in complex cases          coordination of patient-         care coordination and
 coordination                      effectively using                   effectively using                  centered care among              leads in the design and
                                   interprofessional teams             interprofessional teams            different disciplines and        implementation of
                                                                                                          specialties                      improvements

 Identifies key elements           Performs safe and                   Performs safe and                  Models and advocates             Improves quality of
 for safe and effective            effective transitions of            effective transitions of           for safe and effective           transitions of care within
 transitions of care and           care/hand-offs in routine           care/hand-offs in complex          transitions of care/hand-        and across health care
 hand-offs                         situations                          situations                         offs within and across           delivery systems to
                                                                                                          health care delivery             optimize patient outcomes
                                                                                                          systems

 Demonstrates                      Identifies pathology’s role         Identifies opportunities for       Recommends and/or                Leads innovations and
 knowledge of population           in population and                   pathology to participate in        participates in changing         advocates for populations
 and community health              community health needs              community and                      and adapting practice to         and communities with
 needs and disparities             and inequities for their            population health                  provide for the needs of         health care inequities
                                   local population                                                       communities and
                                                                                                          populations

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        10
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Systems-Based Practice 3: Physician Role in Health Care System (AP/CP)

 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., test         complex health care              enhances high-value,
 system (e.g., hospital,           inter-related, and how this         utilization, turnaround            system to provide                efficient, and effective
 skilled nursing facility,         impacts patient care                time)                              efficient and effective          patient care and transition
 finance, personnel,                                                                                      patient care and                 of care
 technology)                                                                                              transition of care

 Describes basic health            Documents testing detail            Engages with clinicians            Practices and                    Participates in health
 payment systems (e.g.,            and explains the impact of          and/or patients in shared-         advocates for cost               policy advocacy activities
 government, private,              documentation on billing            decision making, such as           effective patient care
 public, uninsured care)           and reimbursement                   use of preauthorization for        with consideration of the
 and practice models                                                   complex testing                    limitations of each
                                                                                                          patient’s payment
                                                                                                          model

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                         11
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Systems-Based Practice 4: Informatics (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates familiarity          Understands laboratory              Discusses the role of the          Applies knowledge of             Participates in operational
 with basic technical              specific software, key              pathologist in laboratory          informatics skills as            and strategy meetings,
 concepts of hardware,             technical concepts and              initiatives based on               needed in laboratory             troubleshooting with
 operating systems,                interfaces, workflow,               integrative pathology              initiatives (e.g., data          information technology
 databases, and software           barcode application,                informatics and                    management and                   staff members; able to
 for general purpose               automation systems                  bioinformatics (e.g.,              security, computational          utilize medical informatics
 applications                      (enterprise systems                 laboratory information             statistics, information          in the direction and
                                   architecture)                       system implementation              governance)                      operation of the
                                                                       and configuration, QI                                               laboratory
                                                                       initiatives)

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                         12
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Systems-Based Practice 5: Accreditation, Compliance, and Quality (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates                      Demonstrates knowledge              Identifies the differences         Participates in an               Serves as a resource for
 knowledge that                    of the components of                between accreditation              internal or external             accreditation at the
 laboratories must be              laboratory accreditation            and regulatory                     laboratory inspection            regional or national level
 accredited                        and regulatory                      compliance; discusses
                                   compliance (Clinical                the process for achieving
                                   Laboratory Improvement              accreditation and
                                   Amendments and others),             maintaining regulatory
                                   either through training or          compliance
                                   experience

 Discusses the need for            Interprets quality data and         Demonstrates knowledge             Reviews the quality              Creates and follows a
 quality control and               charts and trends,                  of the components of a             management plan to               comprehensive quality
 proficiency testing               including proficiency               laboratory quality                 identify areas for               management plan
                                   testing results, with               management plan                    improvement
                                   assistance

                                                                       Discusses implications of          Performs analysis and            Formulates a response
                                                                       proficiency testing failures       review of proficiency            for proficiency testing
                                                                                                          testing failures and             failures
                                                                                                          recommends a course
                                                                                                          of action, with oversight

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        13
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Practice-Based Learning and Improvement 1: Evidence-Based Practice and Scholarship (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates how to               Identifies and applies the          Identifies and applies the         Critically appraises and         Teaches others to
 access and select                 best available evidence to          best available evidence to         applies evidence to              critically appraise and
 applicable evidence               guide diagnostic workup             guide diagnostic work-up           guide care, even in the          apply evidence for
                                   of simple cases                     of complex cases                   face of conflicting data         complex cases; and/or
                                                                                                                                           participates in the
                                                                                                                                           development of guidelines

 Aware of the need for             Develops knowledge of               Applies knowledge of the           Proactively and                  Suggest improvements to
 patient privacy,                  the basic principles of             basic principles of                consistently applies             research regulations
 autonomy, and consent             research (demographics,             research such as                   knowledge of the basic           and/or substantially
 as applied to clinical            Institutional Review                informed consent and               principles of research           contributes to the primary
 research                          Board, human subjects),             research protocols to              such as informed                 literature through basic,
                                   including how research is           clinical practice, with            consent and research             translational, or clinical
                                   evaluated, explained to             assistance                         protocols to clinical            research
                                   patients, and applied to                                               practice
                                   patient care

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        14
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Growth (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Accepts responsibility for        Demonstrates openness               Seeks performance data             Actively and                     Models seeking
 personal and                      to receiving performance            and feedback with                  consistently seeks               performance data with
 professional                      data and feedback in                humility                           performance data and             humility
 development by                    order to inform goals                                                  feedback with humility
 establishing goals

 Identifies the gap(s)             Analyzes and reflects on            Institutes behavioral              Critically evaluates the         Teaches others reflective
 between expectations              the factors which                   change(s) to narrow the            effectiveness of                 practice
 and actual performance            contribute to gap(s)                gap(s) between                     behavioral changes in
                                   between expectations and            expectations and actual            narrowing the gap(s)
                                   actual performance                  performance                        between expectations
                                                                                                          and actual 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                   implementing learning
                                   assistance                          learning plan                      effectiveness of the             plans for others
                                                                                                          learning plan and
                                                                                                          improves it when
                                                                                                          necessary

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        15
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Professionalism 1: Professional Behavior and Ethical Principles (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Demonstrates                      Analyzes straightforward            Recognizes the need and            Independently resolves           Identifies and seeks to
 knowledge of the ethical          situations using ethical            uses appropriate                   and manages complex              address system-level
 principles underlying             principles                          resources to seek help in          ethical situations               factors that induce or
 informed consent,                                                     managing and resolving                                              exacerbate ethical
 surrogate decision                                                    complex ethical situations                                          problems or impede their
 making, advance                                                                                                                           resolution
 directives, confidentiality,
 error disclosure,
 stewardship of limited
 resources, and related
 topics

 Describes when and how            Demonstrates insight into           Demonstrates                       Recognizes situations            Coaches others when
 to appropriately report           professional behavior in            professional behavior in           that may trigger                 their behavior fails to
 professionalism lapses,           routine situations; takes           complex or stressful               professionalism lapses           meet professional
 including strategies for          responsibility for own              situations                         and intervenes to                expectations
 addressing common                 professionalism lapses                                                 prevent lapses in self
 barriers; identifies and                                                                                 and others
 describes potential
 triggers for
 professionalism lapses

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                      16
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Professionalism 2: Accountability and Conscientiousness (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Responds promptly to              Takes appropriate                   Recognizes situations              Anticipates and                  Takes ownership of
 instructions, requests, or        ownership and performs              that may impact own                intervenes in situations         system outcomes
 reminders to complete             tasks and responsibilities          ability to complete tasks          that may impact others’
 tasks and responsibilities        in a timely manner with             and responsibilities in a          ability to complete tasks
                                   attention to detail                 timely manner and                  and responsibilities in a
                                                                       describes the impact on            timely manner
                                                                       team
                                                                                                                                           Designs new strategies to
                                                                                                                                           ensure that the needs of
                                                                                                                                           patients, teams, and
                                                                                                                                           systems are met

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                       17
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Professionalism 3: Self-Awareness and Help-Seeking (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Recognizes limitations in         Independently recognizes            Proposes and implements            Independently develops           Serves as a resource or
 the knowledge/skills/             limitations in the                  a plan to remediate or             and implements a plan            consultant for developing
 behaviors of self or              knowledge/skills/                   improve the knowledge/             to remediate or improve          a plan to remediate or
 team, with assistance             behaviors of self or team           skills/behaviors of self or        the knowledge/skills/            improve the knowledge/
                                   and seeks help when                 team, with assistance              behaviors of self or             skills/behaviors
                                   needed                                                                 team

 Recognizes status of              Independently recognizes            Proposes and implements            Independently develops           Coaches others when
 personal and                      status of personal and              a plan to optimize                 and implements a plan            responses or limitations in
 professional well-being,          professional well-being             personal and professional          to optimize personal             knowledge/skills do not
 with assistance                   and seeks help when                 well-being, with                   and professional well-           meet professional
                                   needed                              assistance                         being                            expectations

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                         18
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Interpersonal and Communication Skills 1: Patient and Family-Centered Communication (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Uses language and                 Establishes a relationship          Establishes a relationship         Easily establishes               Mentors others in
 nonverbal behavior to             in straightforward                  in challenging patient             relationships, with              situational awareness and
 demonstrate respect and           encounters using active             encounters, as                     attention to                     critical self-reflection to
 establish rapport                 listening and clear                 appropriate                        patient/family concerns          consistently develop
                                   language                                                               and context, regardless          positive therapeutic
                                                                                                          of complexity                    relationships

 Identifies common                 Identifies complex                  When prompted, reflects            Independently                    Models self-awareness
 barriers to effective             barriers to effective               on personal biases while           recognizes personal              while teaching a
 communication (e.g.,              communication (e.g.,                attempting to minimize             biases while attempting          contextual approach to
 language, disability)             health literacy, cultural)          communication barriers             to proactively minimize          minimize communication
 while accurately                                                                                         communication barriers           barriers
 communicating own role
 within the health care
 system

 Identifies the need to            Organizes and initiates             Sensitively and                    Independently,                   Models shared decision
 adjust communication              communication with                  compassionately delivers           sensitively, and                 making in patient/family
 strategies based on               patient/family by                   medical information,               compassionately                  communication including
 assessment of                     introducing stakeholders,           elicits patient/family             delivers medical                 those with a high degree
 patient/family                    setting the agenda,                 values, goals and                  information, elicits             of uncertainty/conflict
 expectations and                  clarifying expectations             preferences, and                   patient/family values,
 understanding of their            and verifying                       acknowledges uncertainty           goals and preferences,
 health status and                 understanding of the                and conflict, with                 and acknowledges
 treatment options                 clinical situation                  guidance                           uncertainty and conflict

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                         19
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Interpersonal and Communication Skills 2: Interprofessional and Team Communication (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Uses language that                Communicates                        Uses active listening to           Coordinates                      Models flexible
 values all members of             information effectively             adapt communication                recommendations from             communication strategies
 the health care team              with all health care team           style to fit team needs            different members of             that value input from all
                                   members                                                                the health care team to          health care team
                                                                                                          optimize patient care            members, resolving
                                                                                                                                           conflict when needed

 Describes the utility of          Solicits feedback on                Integrates feedback from           Communicates                     Facilitates regular health
 constructive feedback             performance as a                    team members to improve            feedback and                     care team-based
                                   member of the health                communication                      constructive criticism to        feedback in complex
                                   care team                                                              superiors                        situations

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        20
Version 2                                                  Pathology Milestones, ACGME Report Worksheet

 Interpersonal and Communication Skills 3: Communication within Health Care Systems (AP/CP)

 Level 1                           Level 2                             Level 3                            Level 4                          Level 5
 Safeguards patient                Appropriately selects               Communicates while                 Independently                    Guides departmental or
 personal health                   forms of communication              ensuring security of               communicates while               institutional
 information by                    based on context and                personal health                    ensuring security of             communication around
 communicating through             urgency of the situation            information, with guidance         personal health                  policies and procedures
 appropriate means as                                                                                     information                      regarding the security of
 required by institutional                                                                                                                 personal health
 policy (e.g., patient                                                                                                                     information
 safety reports, cell
 phone/pager usage)

 Identifies institutional          Respectfully                        Uses institutional                 Initiates conversations          Facilitates dialogue
 and departmental                  communicates concerns               structure to effectively           on difficult subjects with       regarding systems issues
 structure for                     about the system                    communicate clear and              appropriate                      among larger community
 communication of issues                                               constructive suggestions           stakeholders to improve          stakeholders (institution,
                                                                       to improve the system              the system                       health care system, field)

 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 Pathology Milestones on a non-exclusive basis for educational purposes.
                                                                                                                                                                        21
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