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Competencies, Milestones, NAS

When does a House Officer become an Internist?

A brief primer on the Next Accreditation System

Entrustable Professional Activities (EPAs)

Attributes expected of an Internist in independent practice

EPAs are a set of basic expectations that must be met by a graduating resident in order to practice independently (i.e. become an Internist); these have been developed by an AAIM (Academic Alliance of Internal Medicine) and ABIM (American Board of Internal Medicine.) Residency education, is, thus, designed to ensure these EPAs are met by graduation; while it is not necessary that an individual rotation incorporate experiences to support every EPA, the sum experience of all rotations during residency must. 

Curricular Milestones (CMs)

Level-appropriate expectations that define what it means to be a competent Internist

To demonstrate a graduating resident has met the EPAs, criteria have been developed by AAIm and ABIM for each EPA that should be evaluated and met at expected times during a residents training; these interval-based criteria are termed Curricular Milestones and are Competency-based. Advancement in training requires meeting appropriately-times milestones; failure to do so will result in extension or termination of training. 

The Level appropriate expectations are as follows:



Categories that define what is required to train one to become an Internist

The Curricular Milestones have been developed based on the ACGME-mandated six (6) core competencies:

Putting It All Together

An Example:


Letters: designate the milestone within the competency
Numbers: designate the interval by which the milestone should be met

How we teach and Evaluate the Core Competencies