Presentation Notes

Innovation abstract and poster presented at the AAMC Group on Educational Affairs Regional Spring Conference. April 20-22, 2021; Virtual meeting.


Objective or purpose of innovation: To develop an ACGME-like milestone that concurrently serves as a curriculum blueprint across the continuum of medical education.

Background and/or theoretical framework and importance to the field: In 2019, Milwaukee County became one of the first municipalities to declare racism a public health crisis.(1) Motivated by racial injustice and COVID-19 disparities medical education (2-4) are accelerating efforts to address racism and eliminate health disparities (AAMC’s DEI Cross-Continuum Competencies). Yet, the 2019 ACGME Common Program Requirements six core competencies fails to include the key terms (disparities, inequities, justice, community, underserved) and requires a new structural competency domain with assessments.(5)

Design: To match our existing assessment framework, an ACGME like milestone, applicable across the continuum of medical education was developed by an interprofessional team (eg, MedEd, Ethics, DE&I). A literature review was completed to identify key milestone elements. Milestone was framed by ACGME core competencies (eg, MK, PC, SBP) and progression delineated across five levels. The 8-page milestone was iteratively revised by multiple stakeholders to 1-page suitable for inclusion as the end of each GME program’s required milestone assessment form.

Outcomes: Enthusiastic and pervasive support for the structural fluency milestone was achieved across the continuum. It was approved by GME Council for inclusion as a required formative milestone in every program. GME milestone data informs curriculum/instruction across the continuum (UME, GME, CME) using an expanded 2-page milestone for use as a blueprint at it retained each of the competency domains and references.

Innovation's strengths and limitations: Our milestone innovation recognizes need for data: to monitor our ability to learn/teach and ultimately eliminate racism (and other isms) and health disparities. Its strength is its limitation as we recognize it’s a journey and it will evolve as we do.

Feasibility and transferability for adoption: Formatted like existing ACGME milestones implementation within the assessment system was seamless enhancing its feasibility and transferability.

Document Type





To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.