Evaluating core competency development of Physical Medicine and Rehabilitation residents by Milestones 2.0: A nationwide observational pilot study

Purpose: This study investigated the developmental patterns of Physical Medicine and Rehabilitation (PMR) residency milestones in Taiwan and assessed discrepancies and correlations between resident self-assessments and faculty evaluations using nationwide preliminary Milestones data. Methods: This observational study included residents from all 33 PMR training hospitals between November and December 2024. Both residents (self-assessment) and faculty members completed PMR Milestones 2.0 assessments. A one-way analysis of variance was used to examine differences in sub-competency levels across training years, and polynomial contrast tests were performed to assess linear trends. Differences among competencies/sub-competencies within the same training year were analyzed using generalized estimating equations. Paired t-tests or Wilcoxon signed-rank tests compared raters’ differences, and the intraclass correlation coefficient was calculated for interrater reliability. Results: A total of 331 Milestones worksheets were completed for 172 residents. Significant differences and linear trends were observed in all sub-competencies across training years. Patient Care (PC) 4–7 sub-competencies showed slower progression during R1 and R2 training period, with PC7 showing a similar pattern through R3. Variations in development were noted within the same training year. Although differences in ratings between residents and faculty were present, moderate to high correlations were observed. Conclusion: This study identified both group-level and individual developmental patterns in PMR residency competencies and sub-competencies. Skills requiring greater integration of knowledge and clinical experience progressed more slowly. While raters’ discrepancies existed, correlations remained moderate to high. These findings may guide curriculum mapping, training program redesign, early identification of struggling residents, and the development of improvement strategies.