Endovascular Surgical Neuroradiology Milestones
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Endovascular Surgical Neuroradiology Milestones
The Accreditation Council for Graduate Medical Education
Implementation Date: July 1, 2021
Second Revision: April 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 Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for
educational purposes.Endovascular Surgical 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 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. ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes.
Endovascular Surgical Neuroradiology Milestones
Work Group
Jim Anderson, MD
Laura Edgar, CAE, EdD
Farah Fourcand, MD
Johanna Fifi, MD
Brian Hoh, MD
Paul Jacobson, MD, MPH
Min Park, MD
Howard Riina, MD
The ACGME would like to thank the following organizations for their continued support in the
development of the Milestones:
American Board of Neurological Surgery
American Board of Psychiatry and Neurology
American Board of Radiology
ACGME Review Committees for Neurological Surgery, Neurology, and Radiology
Society of Neurological Surgeons
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive
basis for educational purposes.Understanding 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 resident/fellow. Selection of a level implies the resident/fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v). ©2021 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes.
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 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 Endovascular Surgical Neuroradiology Milestones on a non-exclusive basis for educational purposes.
The 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 Endovascular Surgical Neuroradiology Milestones on a non-exclusive
basis for educational purposes.Version 2 Endovascular Surgical Neuroradiology, ACGME Report Worksheet
Patient Care 1: Pre-Procedural Consultations
Level 1 Level 2 Level 3 Level 4 Level 5
Gathers a complete Chooses pre-procedural Interprets pre-procedural Adjusts procedural plan Mentors other learners in
history and performs a laboratory and imaging imaging studies based upon pre- the pre-procedural
physical studies procedural laboratory consultation
and imaging results
Formulates a pre- Formulates a pre- Independently formulates Independently Develops patient care
procedural assessment procedural assessment pre-procedural formulates pre- protocols/teaching
and plan, including risks, and plan with minimal assessments and plans procedural materials
benefits, and guidance from a faculty for common disorders assessments and plans
alternatives, with member for complex disorders
guidance from a faculty
member
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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Patient Care 2: Performance of Procedures
Level 1 Level 2 Level 3 Level 4 Level 5
Performs basic Performs advanced basic Performs moderately Performs complex Develops new techniques
procedures (e.g., procedures (e.g., spinal complex procedures (e.g., procedures (e.g., or tools
cerebral angiography, angiography, venous coiling of aneurysm, intracranial stent, flow
hemostasis, vascular angiography, Wada test) carotid stent, mechanical diverter, liquid embolics)
access) thrombectomy)
Effectively uses basic Demonstrates basic Integrates catheter and Integrates catheter and
image guidance (e.g., catheter and wire skills wire skills with imaging of wire skills with
visualize needle tip with complex anatomy advanced imaging
ultrasound) guidance and device
utilization
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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Patient Care 3: Post-Procedural Care
Level 1 Level 2 Level 3 Level 4 Level 5
Manages routine post- Manages post-procedural Formulates and Formulates and Mentors other learners in
procedural care with care with minimal implements post- implements post- post-procedural care and
guidance guidance procedural imaging and procedural imaging and management of
clinical follow-up for clinical follow-up for complications
patients after basic patients after complex
procedures procedures
Evaluates post- Manages minor post- Manages major post- Anticipates and Develops a clinical
procedural complications procedural complications procedural complications mitigates post- pathway or guideline for
procedural post-procedural care
complications
Generates reports with Efficiently generates clear Efficiently generates clear Generates tailored
appropriate elements for and concise reports that and concise reports that reports meeting the
coding do not require substantive rarely require correction needs of the care
correction provider and complex
interventional reports
with appropriate
elements for coding
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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Medical Knowledge 1: Imaging and Procedural Anatomy
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Applies knowledge of Applies knowledge of Proficiently integrates Proficiently integrates
knowledge of imaging anatomy to make anatomy to make knowledge of anatomic knowledge of anatomic
anatomy common imaging uncommon imaging imaging with imaging with
diagnoses diagnoses pathophysiology to pathophysiology to
formulate a diagnosis formulate a diagnosis and
treatment plan at the
expected level of a
subspecialist
Identifies normal Identifies anatomic Articulates the Identifies post-operative Develops simulation
anatomy during variants during implications of varying anatomy and its models or other resources
procedures procedures anatomy for procedural implications for
planning procedures
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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Medical Knowledge 2: Physics and Imaging Technology
Level 1 Level 2 Level 3 Level 4 Level 5
Discusses the basic Demonstrates knowledge Applies knowledge of Applies physical Teaches physical
physics for imaging and of basic medical physics basic medical physics and principles to optimize principles to optimize
image-guided and radiobiology in radiobiology to imaging image quality, including image quality to other
intervention imaging and image- and image-guided dose reduction specialties
guided intervention intervention strategies
Discusses imaging Demonstrates knowledge Demonstrates knowledge Proficiently optimizes Presents or publishes
technology and image of basic image acquisition of instrument quality image acquisition and research on imaging
acquisition and image processing, control and image processing in technology
and recognizes common reconstruction; collaboration with the
imaging artifacts and troubleshoots for artifact technology/imaging
technical problems reduction team
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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Medical Knowledge 3: Pathophysiology and Treatment
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Demonstrates knowledge Demonstrates knowledge Demonstrates Contributes to peer-
knowledge of of pathophysiology and of pathophysiology and knowledge of the reviewed literature on
pathophysiology of treatment of patients with treatment of patients with pathophysiologic pathophysiology and/or
common conditions (e.g., common conditions complex conditions (e.g., changes after treatment treatment
stroke, ruptured arteriovenous [AV] fistula,
aneurysm) arteriovenous
malformation [AVM])
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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Medical Knowledge 4: Pharmacology and Contrast
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates basic Demonstrates knowledge Demonstrates knowledge Applies functional Develops pharmacologic
knowledge of the of dosing and drug choice of the indications, knowledge of protocols or departmental
pharmacologic and for contrast agents, contraindications, side- pharmacology to guidelines
contrast agents used in sedation drugs, and effects, and complications endovascular surgical
endovascular surgical commonly used of pharmacologic agents neuroradiology
neuroradiology pharmacologic agents procedures and peri-
procedures
procedural care
Comments:
Not Yet Completed Level 1
Not Yet Assessable
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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 Role models or mentors
knowledge of how to events through of patient safety events to events to patients and others in the disclosure of
report patient safety institutional reporting patients and families families (simulated or patient safety events
events systems (simulated or (simulated or actual) actual)
actual)
Comments:
Not Yet Completed Level 1
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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 institutional or
metrics improvement project community level
Comments:
Not Yet Completed Level 1
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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 in routine patients in complex coordination of patient- care coordination and
coordination in endovascular surgical endovascular surgical centered care among leads in the design and
endovascular surgical neuroradiology neuroradiology different disciplines and implementation of
neuroradiology imaging/procedures imaging/procedures specialties improvements
imaging/procedures effectively using the roles effectively using the roles
of interprofessional team of interprofessional team
members members
Identifies key elements Performs safe and Performs safe and Role models safe and Improves quality of
for safe and effective effective transitions of effective transitions of effective transitions of transitions of care to
transitions of care and care/hand-offs in routine care/hand-offs in complex care/hand-offs optimize patient outcomes
hand-offs clinical situations clinical situations
Demonstrates Identifies specific Identifies local resources Participates in adapting Leads innovations and
knowledge of population population and available to meet the the practice to provide advocates for populations
and community health community health needs needs of a patient for the needs of specific and communities with
needs and disparities and inequities for the local population and populations (actual or health care inequities
population community simulated)
Comments:
Not Yet Completed Level 1
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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 and
technology) efficiency) patient care and transitions of care
transitions of care
Describes the States relative cost of Describes the technical Describes the Participates in health
mechanisms for common procedures and professional endovascular surgical policy advocacy activities
reimbursement, including components of neuroradiology revenue
types of payors neurointerventional cycle and
procedural costs measurements of
productivity (e.g.,
relative value units)
Comments:
Not Yet Completed Level 1
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Systems-Based Practice 5: 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 initiatives at the
injury and the ALARA information exposure to patients and institutional level
(“as low as reasonably practitioners
achievable”) concept
Comments:
Not Yet Completed Level 1
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Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice and Technology Assessment
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 guide routine patient preferences and integrated with patient guide care, tailored to apply evidence for
patient care values to guide evidence- preference and values, to the individual patient complex patients, and/or
based care care for complex patients participates in the
development of guidelines
Discusses the evolution Discusses regulatory Discusses evidence for Critically assesses new
of device or other framework (e.g., FDA, currently available technology and
technology development IRB, HDE) of a device devices, limitations for available evidence
and its consent and use use, and reporting
requirements
Comments:
Not Yet Completed Level 1
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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 Is receptive to Episodically seeks Consistently seeks Coaches other learners to
professional performance data and performance data and performance data and consistently seek
development by feedback and uses them feedback with humility feedback with humility performance data and
establishing goals to inform goals and adaptability and adaptability feedback
Identifies factors that Analyzes, reflects on, and Analyzes effectiveness Coaches others on
contribute to gap(s) Analyzes and reflects on institutes behavioral of behavioral changes, reflective practice
between expectations factors that contribute to change(s) to narrow the where appropriate, and
and actual performance gap(s) between gap(s) between considers alternatives in
expectations and actual expectations and actual narrowing the gap(s)
performance performance between expectations
and actual performance
Actively seeks Designs and implements Uses performance data Facilitates the design and
opportunities to improve Designs and implements a learning plan to measure the implements learning plans
performance a learning plan, with independently effectiveness of the for others
prompting learning plan, and
improves it when
necessary
Comments:
Not Yet Completed Level 1
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Professionalism 1: Professional Behavior and Ethical Principles
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Demonstrates insight into Demonstrates Recognizes situations Coaches others when
knowledge of professional behavior in professional behavior in that may trigger their behavior fails to
expectations for routine situations and complex or stressful professionalism lapses meet professional
professional behavior takes responsibility for situations and intervenes to expectations
and describes how to own professionalism prevent lapses in
appropriately report lapses oneself and others
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 (e.g., ethics resolution
directives, confidentiality, consultations, literature
error disclosure, and review, risk
stewardship of limited management/legal
resources consultation)
Comments:
Not Yet Completed Level 1
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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 Takes ownership of
requests or reminders to responsibilities in a timely responsibilities in a timely awareness of situations system outcomes
complete tasks and manner to ensure the manner to ensure the that may impact others’
responsibilities needs of patients, teams, needs of patients, teams, ability to complete tasks
and systems are met in and systems are met in and responsibilities in a
routine situations complex or stressful timely manner
situations
Comments:
Not Yet Completed Level 1
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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 Coaches others when
personal and status of personal and proposes a plan to a plan to optimize emotional responses or
professional well-being, professional well-being optimize personal and personal and limitations in
with assistance, and is using available resources professional well-being professional well-being knowledge/skills do not
aware of available when appropriate meet professional
resources expectations
Recognizes limits in the Independently recognizes With assistance, Independently develops
knowledge/skills of limits in the proposes a plan to a plan to remediate or
oneself or the team, with knowledge/skills of remediate or improve improve limits in the
assistance oneself or the team and limits in the knowledge/skills of
demonstrates appropriate knowledge/skills of oneself or the team
help-seeking behaviors oneself or the team
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 affect well-being, the mechanisms by which those factors affect well-being, and available resources and tools to improve well-being.
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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 minimizes Coaches other learners to
communicates own role effective communication hinder effective communication barriers minimize 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 other learners in
adjust communication communication with the and compassionately shared decision making shared decision making
strategies based on patient/patient’s family by delivers medical to align patient goals
assessment of the clarifying expectations information, elicits patient and preferences with
patient/patient’s family’s and verifying goals and preferences, treatment options to
expectations and understanding of the and acknowledges make a personalized
understanding of their clinical situation uncertainty and conflict care plan
health status and
treatment options
Comments:
Not Yet Completed Level 1
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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
Uses language that Communicates Uses active listening to Solicits and
values all members of information effectively adapt communication communicates feedback
the health care team with all health care team style to fit team needs to other members of the
members health care team
Comments:
Not Yet Completed Level 1
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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
systems stakeholders (institution,
health care system, field)
Comments:
Not Yet Completed Level 1
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