2047 Delineating Neurosurgery Resident Development: Insights From a Ten-Year National ACGME Milestones and Learning Trajectories From 2013 to 2022

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) Milestones assessment system provides a structured framework for evaluating the developmental progression of neurosurgery residents. Understanding the variability in learning trajectories and identifying critical intervention points are essential for refining educational strategies and enhancing training outcomes. METHODS: In this retrospective cohort study, we analyzed ACGME Milestones data from 3,541 neurosurgery residents across 124 programs from 2013-14 to 2022-23. Through cluster analysis, we identified distinct learning trajectories, focusing on competency-specific developments and crucial intervention points based on divergences in trajectory. RESULTS: Our analysis revealed five distinct learning trajectories among neurosurgery residents, highlighting competency development's diverse and individualized developmental pathways. Cluster 0 (n=1719) and Cluster 1 (n=341) residents demonstrated initial foundational competencies but varied in their progression, with Cluster 1 failing to meet the threshold for independent practice by PGY-7 consistently. Remarkably, Cluster 2 (n=459), starting with the lowest initial competency levels, surpassed independence thresholds, illustrating the efficacy of targeted interventions. Cluster 3 (n=520) and Cluster 4 (n=502) exhibited accelerated competency development, achieving early readiness for independent practice. The analysis underscores the importance of personalized learning plans and strategic educational interventions, especially around critical transitions, such as the end of PGY-2 and PGY-3, to ensure comprehensive readiness for independent neurosurgical practice. CONCLUSIONS: The variability in learning trajectories uncovered through ACGME Milestones data underscores the complexity of neurosurgery residency training. Our findings emphasize the need for adaptive educational strategies tailored to the unique development paths of residents to facilitate their achievement of competency thresholds.