ACGME launched milestone assessments in 2013, formally introducing a developmental framework to gauge the learning trajectory of residents along six core competencies (medical knowledge, patient care, systems-based practice, practice-based learning and improvement, communication, and professionalism). Each competency contains subcompetencies to further specify key skill areas. ACGME required all ACGME-accredited programs to form clinical competency committees (CCCs) to review residents’ written evaluations and assess their achievement of the subcompetencies semi-annually. Residents should demonstrate progression along competency-based descriptors, called milestones, throughout training. Levels do not correspond with post-graduate year—trainees may progress in achievement at varying paces. Milestone assessments are meant to be formative but are reported outside of the program.
(See the figure for the life cycle of milestones assessments, including major inputs and outputs.)

After extensive validity research and input from key stakeholders, ACGME released Milestones 2.0 for Internal Medicine in July 2021 with the goal of improved clarity and harmonization across training fields.1 New competencies emphasize residents’ ability to meet societal needs related to social determinants of health and knowledge of health systems and patients’ payment models when creating care plans. The new assessment scale emphasizes growth mindsets—interns may receive a level of 1 without being “critically deficient.” Supplemental Guides on the ACGME website describe the rationale behind changes and offer assessment tools and resources.2


  1. ACGME. Internal medicine milestones. Second Revision November 2020. Accessed February 15, 2022.
  2. ACGME. Milestones resources. Accessed February 15, 2022.



ACLGIM, Clinical Practice, Health Policy & Advocacy, Leadership, Administration, & Career Planning, Medical Education, Research

Author Descriptions

Dr. Catalanotti ( is division director of General Internal Medicine at The George Washington University School of Medicine and Health Sciences. Dr. Lo ( is professor at University of Florida College of Medicine. Dr. Bates ( is program director in internal medicine at Dignity Health St. Rose Dominican.