# Indigenizing and co-producing the ACGME anesthesiology milestone in Taiwan: a Delphi study and subgroup analysis

## TL;DR

This study adapts North American anesthesiology training standards for use in Taiwan by involving local experts and analyzing differences in competency perspectives across experience levels.

## Contribution

A co-produced, indigenized framework for anesthesiology milestones in Taiwan, highlighting differences in competency priorities among residents and staff.

## Key findings

- Most ACGME anesthesiology milestones are applicable and feasible in Taiwan.
- Residents showed higher concern for professionalism and practice-based learning compared to junior and senior staff.
- Senior staff rated interpersonal and communication skills lower than residents and junior staff.

## Abstract

To implement the ACGME Anesthesiology Milestone Project in a non-North American context, a process of indigenization is essential. In this study, we aim to explore the differences in perspective toward the anesthesiology competencies among residents and junior and senior visiting staff members and co-produce a preliminary framework for the following nation-wide survey in Taiwan.

The expert committee translation and Delphi technique were adopted to co-construct an indigenized draft of milestones. Descriptive analysis, chi-square testing, Pearson correlation testing, and repeated-measures analysis of variance in the general linear model were employed to calculate the F values and mean differences (MDs).

The translation committee included three experts and the consensus panel recruited 37 participants from four hospitals in Taiwan: 9 residents, 13 junior visiting staff members (JVSs), and 15 senior visiting staff members (SVSs). The consensus on the content of the 285 milestones was achieved after 271 minor and 6 major modifications in 3 rounds of the Delphi survey. Moreover, JVSs were more concerned regarding patient care than were both residents (MD = − 0.095, P < 0.001) and SVSs (MD = 0.075, P < 0.001). Residents were more concerned regarding practice-based learning improvement than were JVSs (MD = 0.081; P < 0.01); they also acknowledged professionalism more than JVSs (MD = 0.072; P < 0.05) and SVSs (MD = 0.12; P < 0.01). Finally, SVSs graded interpersonal and communication skills lower than both residents (MD = 0.068; P < 0.05) and JVSs (MD = 0.065; P < 0.05) did.

Most ACGME anesthesiology milestones are applicable and feasible in Taiwan. Incorporating residents’ perspectives may bring insight and facilitate shared understanding to a new educational implementation. This study helped Taiwan generate a well-informed and indigenized draft of a competency-based framework for the following nation-wide Delphi survey.

The online version contains supplementary material available at 10.1186/s12909-024-05081-2.

1. Most ACGME anesthesiology milestones are applicable in Taiwan.

2. Experienced anesthesiologists achieved consensus faster than young practitioners.

3. Residents mirrored milestone competencies through participation.

4. Experience status affected the weight that anesthesiologists gave to milestone competencies.

The online version contains supplementary material available at 10.1186/s12909-024-05081-2.