Kenneth V. Iserson, M.D., MBA
Professor Emeritus, The University of Arizona, Tucson, AZ

Now that you’ve narrowed your interests to a few specialties, how do you learn the specific expectations of each training program?

Actually, it’s easy to locate this information. The Accreditation Council for Graduate Medical Education (ACGME), the group that approves residency programs, has a website ( with listings for each specialty and approved subspecialty. The site has both the general requirements for that specialty and a list of the many technical and knowledge goals that they expect residency graduates to achieve. Called “Milestones,” these are sets of learning points that residents must reach as they progress through their training.

For example, after opening the “Surgery” page, if you select “General Surgery,” located under “Program Requirements,” you will find a boring, but important set of activities such as faculty responsibilities, duty hours, supervision and evaluations that residency programs must perform to remain accredited. Your residency program must be accredited for you to eventually become eligible to take the specialty Board examination.

Then click “Surgery-General” under “Milestones” to view the list of specific competencies that trainees must achieve. All the Milestone lists enumerate the behavior, skills or knowledge that are expected from residents as they progress through a residency program. Some of the Milestones also contain a note about the ultimate needed competency level, as well as what would be considered critical deficiencies. Overall, they provide an easy-to-understand training roadmap for each specialty.

Next you will want to know how different programs in the specialty will help you achieve these Milestones. For that, you need to meet FREIDA, which is the topic of the next column.


Based on: Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition
Tucson, AZ: Galen Press, Ltd.


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