• Syed I Khalid, Ankit I Mehta, Gursant Atwal, Sean O Hogan, Yoon Soo Park, and Fady T Charbel.
• Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
• Neurosurgery. 2024 Dec 19.

Background And ObjectivesThe Accreditation Council for Graduate Medical Education 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. In this article, we aim to identify learning trajectories of neurosurgery residents and pinpoint pivotal junctures for potential interventions to aid residents struggling to meet expected competency levels.MethodsWe analyzed Accreditation Council for Graduate Medical Education Milestones data from 3541 neurosurgery residents across 124 programs from 2013-2014 to 2022-2023. We examined the reliability of Milestone assessments across programs and addressed potential biases because of program-level differences. Through cluster analysis, we identified distinct learning trajectories, focusing on competency-specific developments and crucial intervention points based on divergences in trajectory.ResultsOur analysis revealed 5 distinct learning trajectories among neurosurgery residents, highlighting diverse developmental pathways. Cluster 1 (n = 1,719, 48.5%) and Cluster 2 (n = 341, 9.6%) demonstrated initial foundational competencies but varied in progression, with Cluster 2 failing to meet the threshold for independent practice by postgraduate year 7 consistently. Cluster 3 (n = 459, 13%), starting with the lowest initial competency levels, surpassed independence thresholds, illustrating the potential for significant growth regardless of initial competency levels. Cluster 4 (n = 520, 14.7%) and Cluster 5 (n = 502, 14.2%) exhibited accelerated competency development, achieving early readiness for independent practice. We found no significant association between cluster membership and program characteristics, suggesting that the trajectories reflect individual variations rather than programmatic differences.ConclusionOur findings highlight the need for educational strategies tailored to residents' unique development paths to support the achievement of competency thresholds. While the data suggest potential benefits of adaptive learning, further exploration is required to confirm its impact on educational outcomes.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.

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