The “Next Accreditation System” (NAS) is the ACGME mechanism for evaluating and accrediting residency programs. It is based on learning stages called “Milestones”, which serve as the benchmark for evaluating resident performance in the clinical setting [see Nasca et al The Next GME Accreditation System – Rationale and Benefits, N Engl J Med 366(11):1051-1056, March 15th 2012.].
The Milestones are observable developmental steps that describe a trajectory of academic progress in about 30 domains of neurological training, including history-taking, neurological examination, neurological subspecialties and diagnostic tests. Using the evaluations of resident performance on every rotation, the Department’s Clinical Competency Committee will track each resident’s learning progress, from the first day to graduation, towards the goal of achieving independence for clinical practice. The Milestone evaluations on each resident will be reported to the ACGME twice annually.
Clinical assessments of resident performance will be made using the on-line MedHub system, supplemented by these additional components of evaluation and feedback:
- Faculty evaluation and feedback of resident performance
- At the completion of each clinical rotation, faculty will complete written evaluations using the Medhub system. These evaluations measure a resident’s proficiency of the core competencies through the framework of the Educational Milestones.
- During clinical rotations, the attending will provide verbal feedback during clinical case presentations and review of neuroradiology studies.
- During clinical rotations, the attending will provide verbal evaluation and feedback during bedside history-taking and neurological exam.
- At the mid-point and completion of clinical rotations, faculty will provide verbal feedback to the resident, with a focus on strengths and areas with room for improvement. These evaluations will be modeled on the six core competencies as identified by the ACGME.
- During clinical rotations, the attending with review resident notes – including admission and daily progress notes, procedures notes, as well as discharge summaries. He or she will evaluate notes for appropriate structure, thoughtful differential diagnosis, and formulation of appropriate management plan
- After completion of general neurology inpatient service, stroke inpatient service, consult service - outcomes will be presented at monthly morbidity and mortality conference, where they receive verbal and written feedback on performance by senior faculty.
- Peer evaluations
- Senior residents and clinical fellows evaluate the performance of junior residents with whom they work, particularly in the domains of medical knowledge, patient care, interpersonal skills and communication, and professionalism and will share this information with the faculty member responsible for providing written evaluation of the resident.
- Senior residents and fellows will evaluate competence in procedures, lumbar puncture and stroke thrombolysis, and document successful completion of 5 procedures on Medhub before the resident can perform them independently.
- Junior residents evaluate their senior residents and fellows, particularly addressing the domains of teaching, leadership and team organization and will share this information with the faculty member responsible for providing written evaluation of the resident.
- Residents will be evaluated by the ancillary/support staff on the inpatient services. Support staff will evaluate residents in particular on professionalism, interpersonal skills and communication, patient care, and systems based practice. On a quarterly basis the program directors will collect written evaluations from social workers, nurses, physician extenders, and hospital leadership.
- Program director semi-annual evaluations
- Approximately every six months every resident will meet with either the associate program director or program director. During this meeting, the program directors will review attending, peer, nursing and medical student evaluations, review strengths and areas of improvement, review progress in completing core requirements, and discuss residency and career planning. A summative report of these meetings will be generated for the resident file.
- At the completion of each year of residency training, the program director will complete a summary evaluation that confirms competence to transition to the next PGY year or begin practice without direct supervision.
- Self-assessment
- Residents will evaluate themselves, and use these self-assessments of their own knowledge and skills as a way to address practice-based learning and improvement and foster thoughtful reflection on their own career progress and plans.
- Self-assessment evaluations will be completed prior to meeting with the program director and chair, and reviewed during those meetings
- Residency In-service Training Exam (RITE)
- The RITE is sponsored by the American Academy of Neurology to:
- provide an opportunity for residents to assess their knowledge in neurology and neuroscience;
- Identify areas for further study;
- Serve as a tool for further education by providing references and discussion of each item.
- The test contains approximately 480 multiple choice questions in a single day test, usually administered in late February.
- Scores are reported back to the resident and the department about 6 weeks after the exam and will be reviewed in quarterly meetings.
- The RITE is sponsored by the American Academy of Neurology to:
- Clinical skills evaluation
- As part of the American Board of Psychiatry and Neurology (ABPN) requirements to demonstrate competency in basic clinical skills, residents complete at least five observed history and physicals for which they are evaluated using the ABPN forms.
- Residents are evaluated for competency in medical interviewing skills, neurological examination skills, and humanistic qualities, professionalism and counseling skills.
- The five required patient-scenarios are in critical care, ambulatory (headache, seizures, etc.), neuromuscular, neurodegenerative, and child neurology (or adult neurology for the child neurology residents).
- Completion of these evaluations by faculty is additionally an opportunity for feedback and teaching.
- Two forms used for evaluation of this clinical skills exam are included as an appendix to this packet
- As part of the American Board of Psychiatry and Neurology (ABPN) requirements to demonstrate competency in basic clinical skills, residents complete at least five observed history and physicals for which they are evaluated using the ABPN forms.
- Attendance at Conferences
- Attendance at conferences will be used as one way of assessing professionalism, practice-based learning and improvement.
- Residents are expected to attend all conferences unless exempted because of urgent patient care responsibilities or permission from the Chief Resident or faculty member. Conferences include:
- Daily noon conference didactic lecture series
- Health Disparities
- Grand Rounds
- Morbidity and Mortality
- Journal Club
- Morning report
- Chief of Service
- Monday morning small group sessions (during clinic block)
- Attendance to conferences is mandatory, unless noted otherwise, and will be monitored and reviewed during the semi annual with the program leadership.
- Medical student evaluations
- Following the completion of their clinical neurology rotations, medical students will provide written feedback about their junior and senior residents. This feedback will be review with residents during their meetings with the program directors.
- Praise and Concern Notifications
- Evaluations may also be filled out ad-hoc by any faculty member or peer resident.
The Clinical Competency Committee will use this data to review each resident’s performance and generate and Educational Milestone Assessment on a bi-annual basis. This report will be submitted to the ACGME and will be used to track a resident’s performance and maturation through their residency.
Updated 7/21/25