Table 2.

Classification Scheme Related to How One Might Rate a Resident Who Is Applying for a Fellowship Position at the End of a Reference Letter Based on the “Five Stages of Skill Acquisition”⁴¹,⁴²

Rating	Comparison to Peer Group	Descriptor
Novice*	•Not on track to graduate from program: remediation is unlikely to allow individual to achieve competence	→Below minimal acceptable level of competency
Advanced beginner*	•Not on track to graduate from program: remediation is likely to allow individual to achieve competence	→Below minimal acceptable level of competency
Competent	•Lowest 25% of resident class	→Resident has demonstrated that he has achieved the minimal level of competency to graduate from the residency; however, weaknesses in one or more of the core competencies are apparent
Proficient	•Middle two quartiles	→Resident is solid and reliable and performs at an admirable level
Expert	•Top 25% of resident class	→Resident is acknowledged by the faculty and his peers as an excellent role model. He knows his limitations (which derive primarily from not having experienced certain situations) and seeks guidance appropriately. Nonetheless, he has achieved a level of mastery with regard to the ACGME competencies compared to colleagues at his level.

^*Because the Outcomes Project of the ACGME⁴⁴ requires the attainment of competence as the minimum standard for graduation from a residency program, it would not be possible for a house officer to proceed to fellowship training if he were less than competent.

ACGME, Accreditation Council on Graduate Medical Education.