Orthopedic Surgery Milestones 2.0: Revisiting Program Director Opinion.

OBJECTIVE: The evolved Orthopedic Surgery Milestones 2.0 set was introduced in July 2021 by the ACGME. The purpose of this study was to understand the new version's utility and any challenges. DESIGN, SETTING, PARTICIPANTS: Study recruitment began in 2024 and included an email invitation to orthopedic surgery program directors (PDs) and associate program directors (APDs) from 197 ACGME-accredited programs. Participants were self-selected; survey data was anonymous. Interviews were scheduled and conducted by ACGME employees not associated with the accreditation process. Survey questions measured the utility of and satisfaction with Orthopedic Surgery Milestones 2.0. Relationships among survey items were examined using a prespecified conceptual framework and chi-square test with Bonferroni correction. Template analysis was used to code and analyze the interviews. RESULTS: The online survey response rate was 24%, representing 85 PDs and APDs. Survey respondents reported Milestones 2.0 effectively assessed residents' competency levels and valued structural changes including reorganization of patient care and medical knowledge content. One-on-one interviews were conducted with PDs (17) or APDs (2) from 19 programs. Qualitative analysis highlighted reduced burden, preference for subspecialty-based organization over the previous format of grouping by conditions, and better consistency across rotations, highlighting the range of surgical components. The number of Milestones decreased but PDs reported concern about "box-checking" rather than thoughtful, individualized assessment of resident performance and requested resources to support Milestones implementation. CONCLUSIONS: Survey and interview results reported Orthopedic Surgery Milestones 2.0 to be more representative and less burdensome. However, the shorter, cleaner design did not consistently translate to improved ease of use. More resources are needed for faculty development to support implementation into the clinical environment.