Trainee-Physician Milestones Ratings and Patient Experience Surveys in Early Unsupervised Practice

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Importance: Milestones ratings have been used to assess resident physicians for more than a decade, but little is known as to whether there are posttraining implications of ratings for patient experiences. Objective: To investigate the association of residents' Milestones ratings of professionalism and interpersonal and communication skills (ICS) with patient experience survey results in the first year of unsupervised practice. Design, Setting, and Participants: This retrospective cohort study included physicians who completed residency training at Accreditation Council for Graduate Medical Education-accredited programs between July 1, 2015, and June 30, 2019, and subsequently worked at facilities that collected Clinician & Group-Consumer Assessments of Healthcare Providers and Systems Surveys (CG-CAHPS). Milestones ratings from adult primary care training programs (internal medicine, family medicine, and obstetrics and gynecology) and patient survey data were linked for physicians who had more than 30 CG-CAHPS results in their first year of unsupervised practice. Physician characteristics (sex and specialty), CG-CAHPS patient respondent demographics (sex, race, and language spoken at home), and a CG-CAHPS question about a facility-related experience were collected for multivariable linear regression analyses. Data were analyzed from February 1, 2024 to April 10, 2025. Exposures: Mean professionalism and ICS scores in Milestones evaluations collected 6 months before the end of training. Physicians were categorized into those with higher (≥3.5) or lower (<3.5) mean scores. Main Outcomes and Measures: CG-CAHPS Top Box scores for 6 questions pertaining to physician behaviors and the overall clinician rating. (Top Box scores denote the percentage of patients who selected the most favorable response option.). Results: A total of 1349 physicians (753 [55.8%] aged 26-30 years; 804 [59.6%] female) were included in the analysis. Higher mean professionalism or ICS Milestones ratings were associated with higher Top Box scores across all CG-CAHPS questions pertaining to physician-related experiences (eg, adjusted mean difference in physician's knowledge of the patient's medical history: professionalism, 2.9 [95% CI, 1.4-4.5] percentage points; P < .001; ICS, 3.2 [95% CI, 1.5-4.9] percentage points; P < .001) as well as overall physician ratings (adjusted mean difference: professionalism, 2.9 [95% CI, 1.4-4.3] percentage points; P < .001; ICS, 3.5 [95% CI, 2-5.1] percentage points; P < .001) in multivariable linear regression models. Conclusions and Relevance: In this cohort study of physicians who completed residency in adult primary care specialties, those with higher mean professionalism and ICS Milestones ratings in training received better patient experience survey ratings in their first year of unsupervised practice. These findings suggest that trainees with lower ratings may benefit from intervention.

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