Surgical Milestones Track Resident Skill Progression Better Than Numeric Scores

A mixed-methods study published in BMC Medical Education on 29 August 2026 reports that milestone-based formative assessment documented a progressive pattern of surgical competence aligned with training level among forty-nine residents in an obstetrics and gynecology residency program in Latin America, while the program’s traditional numeric evaluation system yielded uniformly high scores, with a mean of 8 and minimal variation across postgraduate years. Correlations between the two assessment approaches were weak, with Spearman rho values ranging from −0.285 to 0.194, and Wilcoxon signed-rank tests showed statistically significant differences between them across all training years, with p values below 0.05. According to the study team, these results indicate that the adapted milestones offered greater discriminatory capacity than the numeric system in this setting.

Competency-based medical education emphasizes outcomes and developmental progression, yet traditional numeric evaluations often fail to capture changes in surgical competence over time. Surgical milestones provide a structured framework for formative assessment, but their adaptation and use in obstetrics and gynecology surgical training outside high-income settings remains underexplored. The researchers set out to adapt, implement, and evaluate surgical milestones in a gynecology residency program, examining their ability to document operative competence progression and their perceived educational value among residents and faculty.

The team used a convergent mixed-methods design. Four obstetrics and gynecology surgical milestones were translated and culturally adapted using back-translation and a modified Delphi process, a structured consensus method. Milestone-based formative assessments were then implemented during one-month gynecology and minimally invasive surgery rotations, with forty-nine residents across all postgraduate years participating. Quantitative analyses included descriptive statistics, box plots, Wilcoxon signed-rank tests, and Spearman correlation coefficients to compare milestone ratings with the traditional numeric evaluation of surgical skills. Qualitative data were collected through semi-structured interviews with residents and faculty and analyzed using inductive thematic analysis, with integration achieved through a joint display.

The quantitative results showed a clear contrast between the two approaches. Milestone ratings demonstrated a progressive pattern of surgical competence aligned with training level, with senior residents reaching higher developmental levels across most domains. In contrast, the traditional numeric evaluation produced uniformly high scores, with a mean score of 8 and minimal variation across training years, offering little information about how operative skills developed over the course of residency. The weak correlations between milestone ratings and traditional numeric scores, spanning −0.285 to 0.194, together with statistically significant Wilcoxon differences across all postgraduate years, showed that the two systems were measuring competence in substantially different ways and that only the milestone framework distinguished residents at different stages of training.

The qualitative analysis identified five domains related to the assessment experience: understanding the assessment process, improvement in postgraduate education, constructive criticism, monitoring of competence, and quality-focused practice. Participants highlighted the milestones’ role in clarifying expectations, supporting formative feedback, and fostering reflective learning, while also emphasizing the need for coordinated faculty engagement for successful implementation. The study’s authors conclude that the adapted surgical milestones provided meaningful documentation of operative competence progression and greater discriminatory capacity than the traditional numeric evaluation in this gynecology residency program. They note that despite implementation complexity, milestone-based assessment represents a robust approach to evaluating surgical skills and strengthening competency-based surgical education in diverse training contexts. The findings come from a single residency program and one-month rotations, so the team frames the milestones as a formative assessment tool whose adaptation and implementation in other settings would require local cultural adaptation and sustained faculty involvement.

Subject of Research: Implementing milestone-based assessment to document surgical competence progression in an obstetrics and gynecology residency program: a mixed-methods study from Latin America

Article Title: Implementing milestone-based assessment to document surgical competence progression in an obstetrics and gynecology residency program: a mixed-methods study from Latin America

Article References: Rendón-Molina, A., Godines-Enriquez, M. S., Gutiérrez-Cirlos, C., Gómez-Sousa, M. D. L., Hernández-Torres, I., Gorbea-Chávez, V., & Sánchez-Mendiola, M. (2026). Implementing milestone-based assessment to document surgical competence progression in an obstetrics and gynecology residency program: a mixed-methods study from Latin America. BMC Medical Education. https://doi.org/10.1186/s12909-026-10264-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10264-0

Keywords: Implementing, milestone-based, assessment, document, surgical, competence, progression, obstetrics, gynecology, residency, program, mixed-methods