J Surg Educ. 2025 Oct 28:103731. doi: 10.1016/j.jsurg.2025.103731. Online ahead of print.
ABSTRACT
OBJECTIVE: To explore program-level variations in ACGME Milestone 2.0 ratings for Interpersonal & Communication Skills (ICS) and Professionalism (PROF) in general surgery residency programs.
DESIGN: Descriptive analysis of milestone 2.0 ratings using intraclass correlation coefficients (ICCs) to assess program-level variation at each PGY level across ICS and PROF sub-competencies. Wilcoxon Rank Sum tests were conducted to compare program sizes between uniform and nonuniform rating programs.
SETTING: General surgery residency programs across the United States during the 2020 to 2021 academic year.
PARTICIPANTS: About 7,581 residents in PGY1 through PGY5 from 328 general surgery residency programs.
RESULTS: Analysis of descriptive statistics highlighted considerable variation across programs. Analysis of ICC revealed that program-level differences contributed to 0.298 to 0.713 of the total variance in milestone ratings. ICCs were highest in PGY1 and PGY5 residents, suggesting stronger program influence at the start and end of residency. Uniform rating-where all residents at a given PGY level received the same rating-was common, particularly in PGY1 and PGY5, occurring in up to 41.2% of programs. Programs with uniform patterns tended to be smaller in size.
CONCLUSIONS: This study highlights substantial program-level variation in milestone ratings for ICS and PROF across all PGY levels in general surgery residency. High ICCs and uniform rating patterns suggest that milestone ratings may reflect institutional norms rather than resident performance. Future research should explore contributing factors and develop strategies to enhance fairness and quality in resident assessment.
PMID:41162291 | DOI:10.1016/j.jsurg.2025.103731
