ACGME Internal Medicine Milestones Checklist

[comment memo="Patient Care 1: History"]

Level 1
[select name="variable_1" value=" |Elicit and report a comprehensive history for this patient's presentation"]
[select name="variable_1" value=" |Seek data from secondary sources, with guidance"]

[textarea name="" default=""]
[textarea name="" default=""]

Level 2

Elicits and concisely reports a hypothesis driven patient history for common patient presentations
[textarea name="" default=""]

Independently obtain data from secondary sources
[textarea name="" default=""]

Level 3

Elicit and concisely reports a hypothesis-driven patient history this complex patient presentation
[textarea name="" default=""]

Reconcile current data with secondary sources
[textarea name="" default=""]

Level 4

Efficiently elicit and
concisely report a patient history, incorporating pertinent psychosocial and other determinants of health
[textarea name="" default=""]

Use history and secondary data to guide the need for further diagnostic testing
[textarea name="" default=""]

Level 5

Efficiently and effectively tailor the history taking, including relevant historical subtleties, based on patient, family, and system needs
[textarea name="" default=""]

Model effective use of history to guide the need for further diagnostic testing
[textarea name="" default=""]

[comment memo="Patient Care 2: Physical Examination"]


Level 1

Perform a general physical examination while attending to patient comfort and safety
[textarea name="" default=""]

Identify common abnormal findings
[textarea name="" default=""]

Level 2

Document a hypothesis-driven physical examination for a common patient presentation
[textarea name="" default=""]

Interpret common abnormal findings
[textarea name="" default=""]

Level 3

Document a hypothesisdriven physical examination for a complex patient presentation
[textarea name="" default=""]

Identify and interpret uncommon and complex abnormal findings
[textarea name="" default=""]

Level 4

Reference use of advanced maneuvers to elicit subtle findings
[textarea name="" default=""]

Integrate subtle physical examination findings to guide diagnosis and management
[textarea name="" default=""]

Level 5

Model effective evidence-based physical examination technique
[textarea name="" default=""]

Teach the predictive value of the examination findings to guide
diagnosis and management
[textarea name="" default=""]

Patient Care 3: Clinical Reasoning

Level 1 

Organize and accurately summarize information obtained from the patient evaluation to develop a clinical impression
[textarea name="" default=""]

Level 2

Integrate information from all sources to develop a basic differential diagnosis for this patient's presentation
[textarea name="" default=""]

Identify clinical reasoning errors within patient care, with guidance
[textarea name="" default=""]

Level 3

Develop a thorough and prioritized differential diagnosis for this
patient's presentation
[textarea name="" default=""]

Retrospectively apply clinical reasoning principles to identify
errors
[textarea name="" default=""]

 Level 4 

Develop prioritized differential diagnoses in this patient presentation and incorporate subtle, unusual, or conflicting findings
[textarea name="" default=""]

Continually re-appraise the clinical reasoning to improve patient care in real time
[textarea name="" default=""]

Level 5

Develop prioritized differential diagnoses in this complex patient presentation
[textarea name="" default=""]

Model how to recognize error and reflect upon one’s own clinical
reasoning
[textarea name="" default=""]

Patient Care 4: Patient Management – Inpatient

Level 1

Formulate management plan for each
condition, with guidance
[textarea name="" default=""]

Identify opportunities to maintain and promote health
[textarea name="" default=""]

Level 2 

Develop and implement management plans for each condition, recognizing acuity, and modify based on the clinical course
[textarea name="" default=""]

Develop and implement management plans to maintain and promote health, with guidance
[textarea name="" default=""]

Level 3

Develops and implements value-based (high value) management plans for patients with multisystem disease and comorbid conditions; modify based on the clinical course
[textarea name="" default=""]

 Level 4

Independently develop and implement plan to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
[textarea name="" default=""]

Use shared decision making to develop and implement value-based (high value) comprehensive
management plans for this patient's comorbid and multisystem disease, including those conditions requiring critical care
[textarea name="" default=""]

Level 5

Independently develop and implements comprehensive plans to maintain and promote health, incorporating pertinent psychosocial and other determinants of health
[textarea name="" default=""]

Develop and implement comprehensive
management plans for rare or ambiguous presentations or unusual comorbid conditions
[textarea name="" default=""]
Patient Care 1: History

Level 1






Level 2

Elicits and concisely reports a hypothesis driven patient history for common patient presentations


Independently obtain data from secondary sources


Level 3

Elicit and concisely reports a hypothesis-driven patient history this complex patient presentation


Reconcile current data with secondary sources


Level 4

Efficiently elicit and
concisely report a patient history, incorporating pertinent psychosocial and other determinants of health


Use history and secondary data to guide the need for further diagnostic testing


Level 5

Efficiently and effectively tailor the history taking, including relevant historical subtleties, based on patient, family, and system needs


Model effective use of history to guide the need for further diagnostic testing


Patient Care 2: Physical Examination


Level 1

Perform a general physical examination while attending to patient comfort and safety


Identify common abnormal findings


Level 2

Document a hypothesis-driven physical examination for a common patient presentation


Interpret common abnormal findings


Level 3

Document a hypothesisdriven physical examination for a complex patient presentation


Identify and interpret uncommon and complex abnormal findings


Level 4

Reference use of advanced maneuvers to elicit subtle findings


Integrate subtle physical examination findings to guide diagnosis and management


Level 5

Model effective evidence-based physical examination technique


Teach the predictive value of the examination findings to guide
diagnosis and management


Patient Care 3: Clinical Reasoning

Level 1

Organize and accurately summarize information obtained from the patient evaluation to develop a clinical impression


Level 2

Integrate information from all sources to develop a basic differential diagnosis for this patient's presentation


Identify clinical reasoning errors within patient care, with guidance


Level 3

Develop a thorough and prioritized differential diagnosis for this
patient's presentation


Retrospectively apply clinical reasoning principles to identify
errors


Level 4

Develop prioritized differential diagnoses in this patient presentation and incorporate subtle, unusual, or conflicting findings


Continually re-appraise the clinical reasoning to improve patient care in real time


Level 5

Develop prioritized differential diagnoses in this complex patient presentation


Model how to recognize error and reflect upon one’s own clinical
reasoning


Patient Care 4: Patient Management – Inpatient

Level 1

Formulate management plan for each
condition, with guidance


Identify opportunities to maintain and promote health


Level 2

Develop and implement management plans for each condition, recognizing acuity, and modify based on the clinical course


Develop and implement management plans to maintain and promote health, with guidance


Level 3

Develops and implements value-based (high value) management plans for patients with multisystem disease and comorbid conditions; modify based on the clinical course


Level 4

Independently develop and implement plan to maintain and promote health, incorporating pertinent psychosocial and other determinants of health


Use shared decision making to develop and implement value-based (high value) comprehensive
management plans for this patient's comorbid and multisystem disease, including those conditions requiring critical care


Level 5

Independently develop and implements comprehensive plans to maintain and promote health, incorporating pertinent psychosocial and other determinants of health


Develop and implement comprehensive
management plans for rare or ambiguous presentations or unusual comorbid conditions

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