Appendix R – ACGME Dermatology Milestones 2.0

Dermatology Milestones
The Accreditation Council for Graduate Medical Education
AGGME
Second Revision: April 2020
First Revision: June 2014
©2020 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Dermatology Milestones on a non-exclusive basis for educational purposes.

Dermatology Milestones
The Milestones are designed only for use in evaluation of residents in the context of their participation in
ACGME-accredited residency programs. The Milestones provide a framework for the assessment of the
development of the resident in key dimensions of the elements of physician competence 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.
©2020 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Dermatology Milestones on a non-exclusive basis for educational purposes.

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Work Group
V
William Aughenbaugh, MD
Anna Bruckner, MD
Laura Edgar, EdD, CAE
Alexa Leone, DO
Erin Mathes, MD
Kiran Motaparthi, MD
Rona
David RI
Erik
Ashley’
The ACGME would like to thank the following organizations for their continue
development of the Milestones:
American Board of Dermatology
Review Committee for Dermatology

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This document presents the Milestones, which programs use in a semi-annual review of resident |
the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGI
developmental framework. The narrative descriptions are targets for resident performance throug
Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving
the specialty or subspecialty. For each reporting period, the Clinical Competency Committee will r
to select the milestone levels that best describe each learner’s current performance, abilities, and
subcompetency.
These levels do not correspond with post-graduate year of education. Depending on previous exp
achieve higher levels early in his/her educational program just as a senior resident may be at a lo
educational program. There is no predetermined timing for a resident to attain any particular level
achievement of their milestones. This may happen for many reasons, such as over scoring in a pr
experience in a particular procedure, or a significant act by the resident.
Selection of a level implies the resident substantially demonstrates the milestones in that level, as
(see the diagram on page vi).

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Level 4 is designed as a graduation goal but does not represent a graduation requirement. Makin
graduation and unsupervised practice is the purview of the program director. Furthermore, Milest
changes that preclude using Milestones as a sole assessment in high-stakes decisions (i.e., detel
certification or credentialing). Level 5 is designed to represent an expert resident whose achiever
greater than the expectation. Milestones are primarily designed for formative, developmental purp
quality improvement for individual learners, education programs, and the specialty. The ACGME E
evaluate and perform research on the Milestones to assess their impact and value.
Examples are provided for some milestones within this document. Please note: the examples are
outcome; they are provided as a way to share the intent of the element.
Some milestone descriptions include statements about performing independently. These activities
ACGME supervision guidelines as described in the Program Requirements, as well as to institutio
example, a resident who performs a procedure independently must, at a minimum, be supervised
A Supplemental Guide is also available to provide the intent of each subcompetency, examples fc
methods or tools, and other available resources. The Supplemental Guide, like examples containe
designed only to assist the program director and Clinical Competency Committee, and is not mea
element or outcome.
Additional resources are available in the Milestones section of the ACGME website. Follow the lin
www.acgme.org.

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Report Worksheet. For each reporting period, a resident’s performance on the milestones 1
indicated by selecting the level of milestones that best describes that resident’s performan‹
Systems-Based Practice 2: System Navigation for Patient Centered Care
Level 1
Demonstrates
knowledge of care
coordination
Identifies key elements
for safe and effective
transitions of care and
handoffs
Level 2
Coordinates care of
patlents in routine clinical
situations effectively
utilizing the roles of the
interprofessional teams
Performs safe and
effective transitions of
care/handoffs in routine
clinical situations
Level 3
Coordinates care of
patients in complex
clinical situations
effectively utilizing the
roles of their
interprofessional teams
Performs safe and
effective transitions of
care/handoffs in complex
clinical situations
Demonstrates
knowledge of population
and community health
needs and disparities
Identifies specific
population and
community health needs
and inequlties for their
local population
Uses local resources
effectively to meet the
needs of a patient
population and
community
Level 4
Leads effective
coordination of patient-
centered care among
different disciplines and
specialties
A
le
in
in
Advocates for safe and
effective transitions of
care/handoffs within
and across healthcare
delivery systems
including outpatient
settings
In
tri
Participates in changing | L
and adapting practice to
al
provide for the needs of
al
specific populations
hi
Comments:
Selecting a response box in the
middle of a level implies that
milestones in that level and in lower
levels have been substantially
demonstrated.
Not Yet Com
Selecting a response b
between levels indicate
in lower levels have be
demonstrated as well a
milestones in the highe

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Patient Care 1: Medical Dermatology
Level 1
Obtains basic
dermatologic history and
physical exam
Identifies management
options for common
dermatologic conditions
Level 2
Evaluates patients with
common dermatologic
conditions, with
assistance
Manages patients with
common dermatologic
conditions, with
assistance
Level 3
Independently evaluates
patients with common
dermatologic conditions
Independently manages
patients with common
dermatologic conditions
Level 4
Independently evalu
patients with comple
dermatologic conditi
Independently mana
patients with comple
dermatologic conditi
and/or comorbidities
Comments:
Not
Not

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Patient Care 2: Pediatric Dermatology
Level 1
Obtains basic
dermatologic history and
physical exam in a
pediatric patient
Level 2
Evaluates patients with
common pediatric
dermatologic conditions,
with assistance
Level 3
Independently evaluates
patients with common
pediatric dermatologic
conditions
V
Level 4
Independently
evaluates patients v
complex pediatric
dermatologic condit
Identifies management
options for common
pediatric dermatologic
conditions
Manages patients with
common pediatric
dermatologic conditions,
with attention to age,
weight, and psychosocial
considerations, with
assistance
Independently manages
patients with common
pediatric dermatologic
conditions with attention
to age, weight, and
psychosocial
considerations
Describes the challenges
of procedures on
pediatric patients
Assists in procedures on
pediatric patients
Performs basic
procedures on pediatric
patients with assistance
using patient comfort
Independently man:
patients with compl
pediatric dermatolos
conditions and/or
comorbidities, with
attention to age, we
and psychosocial
considerations
Independently perfo
basic procedures or
dediatric patients u
atient comfor
strategies
C
Comments:
Not
Not

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Patient Care 3: Dermatologic Procedures and Surgery
Level 1
Performs pre-operative
assessment for basic
procedures, with
guidance
Level 2
Performs pre-operative
assessment for basic
procedures
Level 3
Performs pre-operative
assessment and
counseling of risk for
excisions and layered
closures, with guidance
Performs basic
procedures, with
guidance
Performs basic
procedures
Performs excisions and
layered closures, with
guidance
V
Level 4
Performs pre-opera
assessment and
counseling of risk fo
complex procedure:
Performs excisions
layered closures;
designs flaps and gi
where indicated
Provides basic wound
care instructions
Provides anticipatory
guidance for procedural
outcomes
Identifies and manages
procedural complications,
with guidance
Identifies and mana
procedural
complications
Comments:
Not
Not

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V
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Patient Care 4: Dermatopathology
Level 1
Identifies key structural
and cellular components
of the skin, hair, and
nails
Level 2
Identifies microscopic
features of common
neoplasms and
inflammatory reaction
patterns
Reviews reported
histologic findings
Performs
clinicopathologic
correlation, with guidance
Level 3
Interprets microscopic
features of common
disorders of the skin, hair,
and nails, with guidance
V
Independently performs
clinicopathologic
correlation for
straightforward
presentations
C
Level 4
Independently inter
microscopic feature
common and
uncommon disorder
the skin, hair, and n
Independently perfo
clinicopathologic
correlation for atypic
or complex
presentations
Comments:
Not
Not

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Patient Care 5: Cosmetic Care
Level 1
Identifies patients with a
cosmetic concern
Level 2
Gathers patient data,
including cosmetic and
relevant medical history
Level 3
Evaluates patient and
recommends
interventions to meet
patient goals for cosmetic
care, with assistance
Describes available
cosmetic treatments
Selects cosmetic
treatment, with assistance
Level 4
Independently
evaluates routine
patient and
recommends
interventions to met
patient goals for
cosmetic care
Delivers cosmetic
treatment and mana
complications, with
assistance
Comments:
Not
Not

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Patient Care 6: Diagnostics
Level 1
Describes indications
and steps involved in in-
office testing
Level 2
Selects and performs in-
office tests, with
assistance
V
Describes laboratory,
imaging, and other
diagnostic testing used
in dermatology
Selects laboratory,
imaging, and other
diagnostic tests for
common presentations,
with assistance
Level 3
Independently selects and
performs in-office test;
interprets in-office
diagnostic tests, with
assistance
Independently interprets
laboratory, imaging, and
other diagnostic tests for
common presentations
Level 4
Independently selec
performs, and interr
a full spectrum of in
office tests
Independently intert
aboratory, imagın
ther diagnostic te
for complex or rare
presentations
Comments:
Not
Not

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Patient Care 7: Critical Thinking/Differential Diagnosis
Level 1
Develops a differential
diagnosis for common
presentations, with
guidance
Level 2
Independently develops a
differential diagnosis for
common presentations
Level 3
Develops a prioritized
differential diagnosis for
complex presentations
and identifies clinical
reasoning errors
Level 4
Pursues and
synthesizes additio
information to react
high-probability
diagnoses with
continuous re-appri
Comments:
Not
Not

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Patient Care 8: Therapeutics Management
Level 1
Identifies patients who
are candidates for topical
and systemic therapy
Level 2
Provides appropriate
counseling regarding
adverse effects and
reasonable risks
Identifies available
treatment options for
common skin disorders
Selects treatment options
for common skin
disorders, with guidance
Level 3
Consistently evaluates
treatment response and
counsels patients on
expectations of therapy
With guidance, selects
therapeutic modalities for
common and uncommon
skin disorders while
balancing risks and
benefits
V
Identifies therapeutic
gents which require
aboratory monitorin
Selects appropriate
laboratory monitoring for
systemic treatments, with
guidance
Selects appropriate
laboratory monitoring and
manages adverse effects,
with guidance
Level 4
Consistently identifi
refractory disease a
independently escal
therapy as necessa
Independently selec
therapeutic modaliti
for common and
uncommon skin
disorders based on
stepwise therapeuti
ladders
Independently order
appropriate laborat
monitoring and
manages adverse
effects
Comments:
Not
Not

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Medical Knowledge 1: Knowledge of Dermatologic Disease
Level 1
Describes fundamental
cutaneous anatomy and
physiology
Level 2
Describes
pathophysiology of
common skin disorders
Level 3
Demonstrates knowledge
of the pathophysiology of
complex skin disorders
V
Demonstrates
knowledge of the clinical
features of common
dermatologic disorders
Demonstrates knowledge
of the clinical features,
associations, treatments,
and expected course of
common dermatologic
disorders
Demonstrates knowledge
of the clinical features,
associations, treatments,
and expected course of
uncommon and complex
dermatologic disorders
Level 4
Synthesizes knowle
of pathophysiology,
skin disorders from
multiple sources
Demonstrates
comprehensive
knowledge of the
clinical features,
associations,
treatments, and
expected course of
common, uncommo
and complex
dermatologic disord
Comments:
Not
Not

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Medical Knowledge 2: Visual Recognition
Level 1
Identifies common
diseases with
characteristic findings
Level 2
Identifies uncommon
diseases with
characteristic findings
Level 3
Identifies variable
presentations of common
disease
Defines primary lesions
and secondary features
Describes morphology,
with assistance
Describes morphology
with fluency
Integrates visual
diagnostic tools (e.g.,
dermoscopy), with
assistance
Level 4
Identifies variable
presentations of
uncommon and rare
disease
Identifies subtle
morphologic variabi
Independently
integrates visual
diagnostic tools
C
Comments:

V
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Systems-Based Practice 1: Patient Safety and Quality Improvement
Level 1
Demonstrates
knowledge of common
safety events
Level 2
Identifies system factors
that lead to safety events
Level 3
Participates in analysis of
safety events (simulated
or actual)
V
Demonstrates
knowledge of how to
report patient safety
events
Demonstrates
knowledge of basic
quality improvement
nethodoloaies and
metrics
Reports patient safety
events through
institutional reporting
systems
Describes local quality
improvement initiatives
(e.g., handwashing,
needle stick prevention,
wrong site surgery
prevention)
Participates in disclosure
of patient safety events to
patients and families
(simulated or actual)
Level 4
Conducts analysis c
safety events and o
error prevention
strategies (simulate
actual)
Discloses patient sa
events to patients a
families (simulated
actual)
Participates in local
quality improvement
initiatives
Demonstrates the s
required to identify,
develop, implement
and analyze a qualit
improvement projec
C
Comments:
Not

V
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Systems-Based Practice 2: System Navigation for Patient-Centered Care
Level 1
Demonstrates
knowledge of care
coordination
Level 2
Coordinates care of
patients in routine clinical
situations effectively using
the roles of the
interprofessional teams
Level 3
Coordinates care of
patients in complex
clinical situations
effectively using the roles
of their interprofessional
teams
Identifies key elements
for safe and effective
transitions of care and
hand-offs
Performs safe and
effective transitions of
care/hand-offs in routine
clinical situations
Performs safe and
effective transitions of
care/hand-offs in complex
clinical situations
V
Level 4
Leads effective
coordination of patie
centered care amon
different disciplines
specialties
Demonstrates
knowledge of population
and community health
needs and disparities
Identifies specific
population and
community health needs
and inequities for their
local population
Uses local resources
effectively to meet the
leeds of a patier
opulation an
community
Advocates for safe :
effective transitions
care/hand-offs withi
and across health c
delivery systems
including outpatient
settings
Participates in chan
and adapting practic
provide for the need
specific populations
Comments:
Not

V
V
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V
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Systems-Based Practice 3: Physician Role in Health Care Systems
Level 1
Identifies key
components of the
complex health care
system
Level 2
Describes how
components of a complex
health care system are
interrelated, and how this
impacts patient care
Level 3
Discusses how individual
practice affects the
broader system
V
Describes basic health
payment systems and
practice models
Delivers care with
consideration of each
patient’s payment model
Engages with patients in
shared-decision making,
informed by each
patient’s payment models
Identifies basic practice
management knowledge
domains for effective
transition to practice
Describes core
administrative knowledge
needed for transition to
practice
Demonstrates use of
information technology
required for medical
practice
Level 4
Manages various
components of the
complex health care
system to provide
efficient and effectiv
patient care
Advocates for patier
care needs with
consideration of the
limitations of each
patient’s payment
model
Analyzes individual
practice patterns an
professional
requirements in
preparation for prac |
C
Comments:
Not

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Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice
Level 1
Demonstrates how to
access and use available
evidence, and
incorporate patient
preferences and values
in order to take care of a
routine patient
Level 2
Articulates clinical
questions and elicits
patient preferences and
values in order to guide
evidence-based care
Level 3
Locates and applies the
best available evidence,
integrated with patient
preference, to the care of
complex patients
Level 4
Critically appraises
applies evidence ev
in the face of
uncertainty and
conflicting evidence
guide care, tailored
the individual patien
Comments:
Not

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Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Gr
Level 1
Accepts responsibility for
personal and
professional
development by
establishing goals
Level 2
Demonstrates openness
to performance data
(feedback and other
input) in order to inform
goals
Identifies the factors
which contribute to
gap(s) between
expectations and actual
performance
Analyzes and reflects on
the factors which
contribute to gap(s)
between expectations and
actual performance
Actively seeks
opportunities to improve
Designs and implements
a omning plan, with
Level 3
Seeks performance data
episodically, with
adaptability and humility
Analyzes, reflects on, and
institutes behavioral
change(s) to narrow the
gap(s) between
expectations and actual
performance
Independently creates
and implements a
learning plan
Level 4
Intentionally seeks
performance data
consistently with
adaptability and hur
Challenges own
assumptions and
considers alternativi
narrowing the gap(s
between expectatio
and actual performa
Uses performance (
to measure the
effectiveness of the
learning plan and w
necessary, improve
Comments:
Not 1

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Professionalism 1: Professional Behavior and Ethical Principles
Level 1
Identifies and describes
potential triggers for
professionalism lapses
Level 2
Demonstrates insight into
professional behavior in
routine situations
Level 3
Demonstrates
professional behavior in
complex or stressful
situations
V
Level 4
Recognizes situatio
that may trigger
professionalism lap:
and intervenes to
prevent lapses in se
and others
Describes when and how
to appropriately report
professionalism lapses,
including strategies for
addressina common
barriers
Demonstrates
knowledge of medical
ethical principles
Takes responsibility for
own professionalism
lapses
Recognizes need to seek
help in managing and
resolving complex ethical
situations
Recognizes and ust
appropriate resourc
for managing and
resolving ethical
dilemmas, as neede
Analyzes straightforward
situations using ethical
principles
Analyzes complex
situations using ethical
principles
Comments:
Not

V
V
V
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Professionalism 2: Accountability/Conscientiousness
Level 1
Responds promptly to
requests or reminders to
complete tasks
Level 2
Performs tasks and
responsibilities in a timely
manner with appropriate
attention to detail in
routine situations
Level 3
Performs tasks and
responsibilities in a timely
manner with appropriate
attention to detail in
complex or stressful
situations
Takes responsibility for
failure to complete tasks
and responsibilities
Recognizes situations
that may impact own
ability to complete tasks
and responsibilities in a
timely manner
Proactively ensures that
the needs of patients are
met
V
Level 4
Mitigates situations
may impact others’
ability to complete ti
and responsibilities
timely manner
Implements strategi
to enhance
accountability of tea
members involved il
patient care
Comments:
Not

V
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Professionalism 3: Self-Awareness and Help-Seeking
Level 1
Recognizes status of
personal and
professional well-being,
with assistance
Recognizes limits in
one’s own knowledge/
skills, with assistance
Level 2
Independently recognizes
status of personal and
professional well-being
Independently recognizes
limits in one’s own
knowledge/skills and
seeks help when
appropriate
Level 3
Proposes a plan to
optimize personal and
professional well-being,
with assistance
Proposes a plan to
remediate or improve
limits in one’s own
knowledge/skills, with
assistance
Level 4
Independently deve
a plan to optimize
personal and
professional well-be
Independently deve
a plan to remediate
improve limits in ont
own knowledge/skill
Comments:
Not

V
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Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
Level 1
Uses language and
nonverbal behavior to
demonstrate respect and
establish rapport
Level 2
Establishes a therapeutic
relationship in
straightforward
encounters using active
listening and clear
language
Level 3
Establishes a therapeutic
relationship in challenging
patient encounters, with
guidance
Level 4
Independently
establishes a
therapeutic relations
in challenging patie
encounters
Identifies common
barriers (e.g., language)
to effective
communication
Identifies complex
barriers (e.g., health
literacy) to effective
communication
When prompted, reflects
on personal biases while
attempting to minimize
communication barriers
Identifies the importance
of engaging in shared
decision making
Identifies elements of
shared decision making
Uses shared decision
making to make a
personalized care plan,
with quidance
Independently
recognizes persona
biases while attemp
to proactively minim
communication barr
Independently uses
shared decision ma
to make a personali
care plan
Comments:
Not

V
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Interpersonal and Communication Skills 2: Interprofessional and Team Communication
Level 1
Respectfully requests a
consultation
Respectfully receives a
consultation request
Jses language that
values all members of
the health care team
Level 2
Clearly and concisely
requests a consultation
Clearly and concisely
responds to a
consultation request
Solicits feedback on
performance as a
member of the health
care team
Level 3
Checks own
understanding of
consultant
recommendations
Level 4
Checks understanding of
recommendations when
providing consultation
Communicates concern:
and provides feedback to
peers and learners
V
Coordinates
recommendations fr
different members c
the health care tean
optimize patient car
Communicates
feedback and
constructive criticisr
superiors
Comments:
Not

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Interpersonal and Communication Skills 3: Communication within Health Care Systems
Level 1
Accurately records
information in the
electronic health record
(EHR) in a timely
manner
Safeguards protected
health information by
using appropriate
communication channels
Level 2
Demonstrates organized
diagnostic and
therapeutic reasoning
through notes in the EHR
Uses documentation tools
and short cuts (e.g.,
copy/paste) accurately
and appropriately, per
institutional policy
Level 3
Concisely reports
diagnostic and
therapeutic reasoning in
the EHR
Appropriately selects and
uses direct (e.g.,
telephone, in-person) and
indirect (e.g., progress
notes, text and inbo›
nessages) forms of
communication based on
context
Level 4
Communicates clea
concisely, and in an
organized written fo
including anticipator
guidance
Achieves written or
verbal communicati
(e.g., patient notes,
email) that serves a
example for others 1
follow
Comments:
Not