The Blood Banking and Transfusion Medicine
Milestone Project
A Joint Initiative of
The Accreditation Council for Graduate Medical Education
and
The American Board of Pathology
July 2015
i
The Blood Banking and Transfusion Medicine Milestone Project
The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGME-
accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the
development of the fellow in key dimensions of the elements of physician competency in a specialty or subspecialty.
They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed
to be relevant in any other context.
ii
Blood Banking and Transfusion Medicine Milestones
Chair: Mark Brissette, MD
Working Group Advisory Group
Ronald E. Domen, MD C. Bruce Alexander, MD
Laura Edgar, EdD, CAE Julia C. Iezzoni, MD
James R. Stubbs, MD Rebecca Johnson, MD
Wesley Y. Naritoku, MD, PhD
iii
Milestone Reporting
This document presents Milestones designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME.
Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental
framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship
through graduation. In the initial years of implementation, the Review Committee will examine Milestone performance data for each
program’s fellows as one element in the Next Accreditation System (NAS) to determine whether fellows overall are progressing.
For each period, review and reporting will involve selecting milestone levels that best describe each fellow’s current performance and
attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert
in the subspecialty. These levels do not correspond with post-graduate year of education.
Selection of a level implies that the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the
diagram on page v).
Level 1: The fellow demonstrates milestones expected of an incoming fellow.
Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level.
Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones
targeted for fellowship.
Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is
designed as the graduation target.
Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating “aspirational” goals which might
describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional
fellows will reach this level.
iv
Additional Notes
Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for
graduation is the purview of the fellowship program director. Study of Milestone performance data will be required before the ACGME and
its partners will be able to determine whether milestones in the first four levels appropriately represent the developmental framework, and
whether Milestone data are of sufficient quality to be used for high-stakes decisions.
Examples are provided with some milestones. Please note that the examples are not the required element or outcome; they are provided as
a way to share the intent of the element.
Some milestone descriptions include statements about performing independently. These activities must occur in conformity to the ACGME
supervision guidelines, as well as to institutional and program policies. For example, a fellow who performs a procedure independently must,
at a minimum, be supervised through oversight.
Answers to Frequently Asked Questions about Milestones are available on the Milestones web page:
http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.
v
The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report
Worksheet. For each reporting period, a fellow’s performance on the milestones for each sub-competency will be indicated by
selecting the level of milestones that best describes that fellow’s performance in relation to those milestones.
Selecting a response box on the line in
between levels indicates that milestones in
lower levels have been substantially
demonstrated as well as some milestones in
the higher level(s).
Selecting a response box in the middle of
a level implies that milestones in that
level and in lower levels have been
substantially demonstrated.
Version 5/2014 Blood Banking and Transfusion Medicine Milestones: ACGME Report Worksheet
Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 1
PC1 — Consultation
Level 1
Level 2
Level 3
Level 4
Level 5
Understands the role of the
consultant in blood
banking/transfusion
medicine (BB/TM) (including
therapeutic apheresis)
Observes and assists in the
consultation
Able to use the electronic
medical record (EMR) and
other electronic resources
to obtain clinical and disease
information
Performs timely, clinically
useful consultation for
requests for blood products,
apheresis, transfusion
reactions, and other
immunohematology work-
ups and evaluations
Independently prepares full
and complete consultative
reports
Effectively communicates
consultative
recommendations and action
plans
Develops a portfolio of
consultations
Competently and
independently performs
consultation during night
and weekend emergent
situations, as well as during
normal hours
Effectively teaches rotating
residents and fellows in
performing consultations
Demonstrates proficiency at
BB/TM consultation
Comments:
Not yet achieved Level 1
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Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 2
PC2 — Interpretation, Reporting, and Diagnosis
Level 1
Level 2
Level 3
Level 4
Level 5
Observes and assists in the
interpretation of
immunohematology tests
Understands basic
indications for tests
Accurately interprets and
reports results
Understands basic test
platforms and methodology
Prepares a differential
diagnosis for abnormal test
results or findings
Demonstrates knowledge of
the current literature related
to test results and testing
algorithms
Critically evaluates and applies
the current literature
Interacts with other health
care teams to discuss test
results and make
recommendations
Understands justifications
for additional testing
Effectively teaches rotating
residents and fellows in
performing consultations
Demonstrates proficiency in
interpretation, reporting,
and diagnosis in BB/TM
Comments:
Not yet achieved Level 1
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Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 3
PC3 — Procedures
Level 1
Level 2
Level 3
Level 4
Level 5
Understands basic concepts
underlying common
procedures performed in
BB/TM and apheresis
(therapeutic and donor)
Obtains an appropriate
history and performs an
appropriate physical
examination on the
apheresis patient
Understands indications,
contraindications, and
potential complications for
procedures
Applies concepts and
knowledge of therapeutic
apheresis in clinical
situations
Performs a “time-out” and
obtains informed consent
Able to discuss with attending
staff member(s) the role of
the BB/TM physician in
procedures
Actively participates in
apheresis procedures
including therapeutic,
hematopoietic stem cell (HSC)
collection, and donor
collections
Manages therapeutic
apheresis procedures with
minimal oversight
Demonstrates ability to
manage complications and to
support ancillary staff
Documents, and discusses,
with the clinical care team,
indications,
contraindications, and
complications of the
procedure
Demonstrates competence
in the independent
oversight and management
of the procedure in all
settings (as appropriate)
Can independently act in the
role of an apheresis
consultant
Demonstrates proficiency at
BB/TM procedures
Proficient in the oversight
and management of
apheresis in all settings
Comments:
Not yet achieved Level 1
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Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 4
MK1 — Fundamental and Diagnostic Knowledge
Level 1
Level 2
Level 3
Level 4
Level 5
Identifies the key resources
for learning in BB/TM
Demonstrates basic
textbook-level knowledge in
BB/TM
Uses multiple learning
sources to acquire
knowledge
Performs self-directed
learning
Applies evidence-based
medicine principles to patient
care
Teaches rotating residents and
fellows
Demonstrates competence
of knowledge in all aspects
of BB/TM
Teaches across departments
Demonstrates proficiency of
knowledge in all aspects of
BB/TM
Serves as an educational
resource for the community
at-large
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 5
MK2 — Apheresis
Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates knowledge
of the general principles
and risks of apheresis
Demonstrates knowledge
and appropriate use of
basic clinical
tests for
assessment and
management of apheresis
patients
Demonstrates expertise in
the knowledge of diseases
commonly treated with
apheresis
Demonstrate the ability to
manage the unique
problems associated with
apheresis of donors giving
blood component, stem
cells, or cellular therapy
products
Demonstrates competence
in knowledge of common
risk factors in therapeutic
apheresis related to
medications, including ACE
inhibitor use, anti-
diabetic medications,
antibiotics, and
anticoagulants
Proficient in knowledge of
apheresis across all settings
Comments:
Not yet achieved Level 1
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Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 6
SBP1 — Regulatory
Level 1
Level 2
Level 3
Level 4
Level 5
Understands that
laboratories are regulated
by state, federal, and
professional organizations
Understands the use of
proficiency testing
Understands the basics of
quality assurance
Demonstrates compliance
with national regulations for
patient privacy and
confidentiality (e.g., HIPAA,
state laws, institutional
policies)
With substantial guidance
implements state, federal,
and professional
organization standards or
elements of checklists in the
laboratory
Reviews proficiency testing
results
With minimal guidance,
implements state, federal, and
professional organization
standards or elements of
checklists in the laboratory
Able to implement corrective
action based on proficiency
testing results
Participates as a team
member in a mock or actual
inspection of a laboratory or
blood center, or equivalent
(e.g., tracers, self-
inspection)
Actively participates in, or
performs, inspections of a
laboratory or blood center
at an outside facility
Able to lead an inspection of
a laboratory
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 7
SBP2 — Health Care Teams
Level 1
Level 2
Level 3
Level 4
Level 5
Understands the importance
of the transfusion medicine
physician’s role in the health
care team
With substantial guidance,
plays a role in the health
care team (e.g., case
presentation, consultation,
test selection guidance)
With minimal guidance, plays
a role in the health care team
(e.g., case presentation,
consultation, test selection
guidance)
Independently plays a role
in the health care team
(e.g., case presentation,
consultation, test selection
guidance)
Effectively plays a lead role
in the health care team
(e.g., case presentation,
consultation, test selection
guidance)
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 8
SBP3 — Lab Management: Resource Utilization (personnel and finance)
Level 1
Level 2
Level 3
Level 4
Level 5
Aware of the roles of a
transfusion medicine
physician in managing
personnel; interprets an
organizational chart
Recognizes different budget
types (e.g., capital vs.
operating budget)
Knows the personnel and
lines of reporting in the
laboratory
Describes the elements of a
budget (e.g., personnel,
capital equipment)
Describes the process of
personnel management and
employment laws (e.g.,
interview questions, Family
and Medical Leave Act,
termination policies)
Understands the basics of
transfusion medicine practice
finance (e.g., Part A and Part
B, Centers for Medicare &
Medicaid Services [CMS])
Participates in employee
interviews/performance
evaluation (real or
simulated experiences)
Participates in a budget
cycle exercise (draft, defend,
and propose logical cuts
and/or additions)
Manages personnel
effectively
Develops a budget
Comments:
Not yet achieved Level 1
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Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 9
PBLI1 — Evidence-based Utilization
Level 1
Level 2
Level 3
Level 4
Level 5
Understands the importance
of evidence-based utilization
of laboratory tests, results,
blood utilization and
management, and apheresis
With substantial guidance,
critically reviews the
literature addressing
evidence-based utilization of
laboratory tests, results,
blood utilization and
management, and apheresis
With minimal guidance,
critically reviews the literature
addressing evidence-based
utilization of laboratory tests,
results, blood utilization and
management, and apheresis
Independently performs a
critical review of the
literature addressing
evidence-based utilization of
laboratory tests and results,
blood utilization and
management, or apheresis;
and designs utilization
guidelines
Implements institutional
utilization guidelines for
laboratory tests and results,
blood utilization and
management, and apheresis
Comments:
Not yet achieved Level 1
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Copyright (c) Pending. The Accreditation Council for Graduate Medical Education and the American Board of Pathology. All rights reserved. The
copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 10
PBLI2 — Process Improvement and Patient Safety
Level 1
Level 2
Level 3
Level 4
Level 5
Demonstrates awareness of
common sources of error in
laboratory and donor
processes and transitions in
care
Understands the importance
of identity and integrity of
the specimen and
requisition form and verifies
the identity
Consistently demonstrates
work habits that minimize
error; consistently and
promptly communicates
discrepancies to health care
providers (as appropriate)
Consistently checks identity
and integrity of specimen;
independently obtains
clinical information when
needed; incorporates other
resources, such as EMR and
radiology; handles
deviations from policies
(waivers) with supervision
Contributes to practice change
based on an identified error or
systematic problem (e.g.,
post-analytic, pre-analytic,
laboratory, or interpretative)
Trouble-shoots pre-analytic
problems, including deviations
from policies (waivers), with
minimal supervision
Participates in and
completes a laboratory
quality improvement project
Trouble-shoots patient
safety issues (including pre-
analytic, analytic, and post-
analytic)
Routinely uses identified
errors and discrepancies to
improve practice and
laboratory processes
Models patient safety
practices; able to write and
implement policies on
patient safety; completes
maintenance of certification
(MOC) patient safety
module
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 11
PBLI3 — Research and Scholarly Activity
Level 1
Level 2
Level 3
Level 4
Level 5
Has knowledge of the basic
principles of research
(demographics, IRB, human
subjects), including how
research is conducted,
evaluated, explained to
patients, and applied to
patient care
Applies evidence-based
medicine in presentations,
such as at journal club, and,
as appropriate, identifies
research project early in
fellowship
Educates others through
BB/TM journal clubs
Applies evidence-based
medicine in presentations at
local or regional meetings
Completes research project,
if undertaken
Prepares for and presents at
national or international
meetings
Prepares and submits
articles for peer-reviewed
publication
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 12
PROF1 — Receiving and Providing Feedback
Level 1
Level 2
Level 3
Level 4
Level 5
Receives feedback
constructively
Modifies practice in
response to feedback
Consistently receives feedback
and modifies practice
Modifies and maintains
changes in practice based
on feedback
Provides constructive
feedback
Encourages and actively
seeks and provides feedback
to improve performance
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 13
PROF2 — Accountability, Honesty, and Integrity
Level 1
Level 2
Level 3
Level 4
Level 5
Completes assigned tasks on
time
Is honest and understands
the concepts of ethical
behavior; seeks counsel
when ethical questions arise
Reliably completes assigned
tasks in a timely manner;
assists team members when
requested; respects
assigned schedules
Acknowledges personal
limitations, near misses and
errors, and putting the
needs of patients first;
engages in ethical behavior
Anticipates team needs and
steps in to assist as needed
Identifies personal limitations
and takes responsibility for
errors
Anticipates team needs and
takes leadership role to
independently implement
solutions
Institutes corrective
measures for errors
Is viewed by members of
the health care team as
accepting personal
responsibility, and always
putting the needs of the
patient above his/her own
interests
Serves as a role model for
ethical and professional
behavior
Exemplifies effective
management of multiple
competing tasks, with
reliable follow-up; is a
source of support/guidance
to other members of the
health care team
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 14
PROF 3 — Cultural Competency
Level 1
Level 2
Level 3
Level 4
Level 5
Respects diversity and
autonomy; recognizes
vulnerable populations
Embraces diversity and
respects vulnerable
populations; aware of
potential for bias or cultural
differences to affect care
and the workplace
Understands and complies
with institutional policies
affecting cultural
competency
Demonstrates cultural
competency; recognizes
cultural differences that may
affect care and the workplace,
and identifies and avoids
biases
Exemplifies cultural
competency; recognizes
cultural differences, and
identifies and avoids biases
that may affect care and the
workplace
Models cultural
competency, and
recognition of cultural
differences that may affect
care and the workplace;
works with peers to avoid
biases
Comments:
Not yet achieved Level 1
Version 5/2014 Blood Banking and Transfusion Medicine Milestones: ACGME Report Worksheet
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 15
ICS1 — Communication with Health Care Providers, Families, Patients, and Donors (as applicable)
Level 1
Level 2
Level 3
Level 4
Level 5
Understands the importance
of timely and effective
communication with health
care providers, families,
patients, and donors (as
applicable)
Understands that the
written report is a form of
communication that must
be clear and understandable
Effectively utilizes the
electronic health record
With substantial guidance,
provides timely and
effective communication
with health care providers,
families, patients, and
donors (as applicable)
With substantial guidance,
produces a clear and
understandable written
report
With minimal guidance,
provides timely and effective
communication with health
care providers, families,
patients, and donors (as
applicable)
With minimal guidance,
produces a clear and
understandable written report
Effectively communicates
complex, difficult, or
challenging information
(e.g., errors, complications,
adverse events, and bad
news)
Independently and
consistently produces a
clear and understandable
written report
Serves as a role model for
effective and professional
communication to health
care providers, families,
patients, and donors (as
applicable)
Comments:
Not yet achieved Level 1
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copyright owners grant third parties the right to use the Blood banking and Transfusion Medicine Milestones on a non-exclusive bases for educational
purposes. 16
ICS2 — Personnel Management and Conflict Resolution
Level 1
Level 2
Level 3
Level 4
Level 5
Understands the importance
of conflict and complaint
resolution
With substantial guidance
manages conflicts and
complaints
With minimal guidance
manages conflicts and
complaints
Independently manages
conflicts and complaints
Anticipates, mitigates, and
manages potential conflicts
and complaints
Comments:
Not yet achieved Level 1
