{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T16:36:03Z","timestamp":1793205363754,"version":"4.5.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012647","name":"National Board of Medical Examiners","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["AEM Education and Training"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To characterize the extent and domains of variability in Emergency Medicine (EM) residency preparedness by evaluating \u201cNot Yet Level 1\u201d (NotYL1) Accreditation Council for Graduate Medical Education (ACGME) Milestones ratings among US MD\u2010graduated interns at mid\u2010year and end\u2010of\u2010year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This was a national retrospective analysis of ACGME Milestone assessments for 6893\u2009US MD\u2010graduated EM interns from 2021 through 2024. For each of the 22 EM sub\u2010competencies, we calculated the percentages of interns assigned a NotYL1 rating at both the mid\u2010year and end\u2010of\u2010year assessment periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, NotYL1 ratings were &lt;\u20094%. At mid\u2010year, the mean NotYL1 percentage across sub\u2010competencies was 2.5% (range: 1.8%\u20133.3%), decreasing to 0.4% (range: 0.2%\u20131.0%) at end\u2010of\u2010year. At mid\u2010year, the highest proportions of NotYL1 ratings were concentrated in all Systems\u2010Based Practice (SBP) sub\u2010competencies\u2014including Patient Safety (SBP1; 3.0%), Quality Improvement (SBP2; 3.2%), System Navigation (SBP3; 3.0%), and the Physician Role in Health Care Systems (SBP4; 3.3%)\u2014as well as Pharmacotherapy (PC5; 3.1%) and Accountability\/Conscientiousness (PROF2; 3.2%). By end\u2010of\u2010year, nearly all interns achieved Level 1 or higher, though PROF2 remained the highest outlier at 1.0%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>US MD graduates demonstrate strong overall readiness for EM residency, with most initial gaps resolving by the end of the first year. However, consistent mid\u2010year deficits in systems\u2010based practice and professionalism (accountability\/conscientiousness) highlight critical targets for undergraduate medical school accountability, transition\u2010to\u2010residency curricula, and targeted residency onboarding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/aet2.70259","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T03:52:36Z","timestamp":1790049156000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing Residency Readiness: Patterns of \u201cNot Yet Level 1\u201d Milestone Ratings in Emergency Medicine Interns"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-8002","authenticated-orcid":false,"given":"Sally A.","family":"Santen","sequence":"first","affiliation":[{"name":"University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8883-653X","authenticated-orcid":false,"given":"Guiliano L.","family":"Melki","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8787-8152","authenticated-orcid":false,"given":"Amanda R.","family":"Emke","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-4335","authenticated-orcid":false,"given":"Yoon Soo","family":"Park","sequence":"additional","affiliation":[{"name":"University of Illinois College of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3266-9289","authenticated-orcid":false,"given":"Michael S.","family":"Ryan","sequence":"additional","affiliation":[{"name":"University of Virginia  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9006-1857","authenticated-orcid":false,"given":"Sean O.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Accreditation Council for Graduate Medical Education  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2665-5876","authenticated-orcid":false,"given":"Anita Wilson","family":"Scott","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0668-0767","authenticated-orcid":false,"given":"Katherine","family":"Berg","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Alseidi","sequence":"additional","affiliation":[{"name":"University of California, San Francisco  California San Francisco USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8408-2581","authenticated-orcid":false,"given":"Luan","family":"Lawson","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University School of Medicine  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010021\u201002679\u20108"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2024\u2010070307"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/acm.0b013e3181a82426"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000192"},{"key":"e_1_2_11_6_1","unstructured":"Accreditation Council for Graduate Medical Education. 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