by Ming-Li Wang, M.D.; Sara Maria Jensen, M.D.; Peter Muscarella II, M.D. | March 15, 2024 Article Citation: Kendrick DE, Thelen AE, Chen X, Gupta T, Yamazaki K, Krumm AE, Bandeh-Ahmadi H, Clark M, Luckoscki J, Fan Z, Wnuk GM, Ryan AM, Mukherjee B, Hamstra SJ, Dimick JB, Holmboe ES, George BC. Association of Surgical Resident Competency Ratings with Patient Outcomes. Acad Med 2023; 98(7):813-820. DOI: 10.1097/ACM.0000000000005157 What is this article about? This article examines the association of milestone competency ratings of U.S. general surgery residents with patient outcomes in early career practice. The milestones assessment framework is the standard assessment instrument used by every general surgery program accredited by the Accreditation Council for Graduate Medical Education since 2013. Through a retrospective cross-sectional study of a sample of national Medicare claims for 23 common high-risk inpatient general surgery procedures, this study explored milestone ratings of senior surgical residents and their rates of mortality with any complications within 30 days of index operation during the first two years of practice. The article concluded that there was no association between mean milestone competency ratings and subsequent early career patient outcomes. Why should you read the article? Predicting future patient clinical outcomes through educational assessment tools remains a goal for educators everywhere. While milestone ratings are useful for national benchmarking and comparisons across graduate programs, they are fairly blunt instruments for understanding residents’ cognitive and technical performance as they relate to rates of complications during unsupervised practice. Graduate medical education leaders and educators should become familiar with the limitations of milestones as a predictive single assessment tool specific to patient outcome measures as suggested by this study. How can you use this article? Graduate medical leaders and educators may use this article to increase their efforts to improve their ability to link assessment data types together in informative ways. For example, alternative tools, such as entrustable professional activities and video-based assessments, may provide broad information using specific granular data to define behavior. Any consideration of measuring clinical outcomes and resident performance must be framed in the context of the complex environment in which clinical care happens. Further work on linkages between competency frameworks and its associated assessments to clear patient outcomes is needed. Review Author: Ming-Li Wang, M.D.; Associate Professor and Vice Chair of Diversity, Equity and Inclusion, Department of Surgery, University of New Mexico, Albuquerque, NM. Sara Jensen, M.D. and Peter Muscarella II, M.D. co-authored this review. Organization: Association for Surgical EducationAre Surgical Resident Competency Ratings Associated with Patient Outcomes?