Objective or purpose of innovation: To develop an ACGME-like milestone that concurrently serves as a curriculum blueprint across the continuum of medical education.

Background and/or theoretical framework and importance to the field: In 2019, Milwaukee County became one of the first municipalities to declare racism a public health crisis.(1) Motivated by racial injustice and COVID-19 disparities medical education (2-4) are accelerating efforts to address racism and eliminate health disparities (AAMC’s DEI Cross-Continuum Competencies). Yet, the 2019 ACGME Common Program Requirements six core competencies fails to include the key terms (disparities, inequities, justice, community, underserved) and requires a new structural competency domain with assessments.(5)

Design: To match our existing assessment framework, an ACGME like milestone, applicable across the continuum of medical education was developed by an interprofessional team (eg, MedEd, Ethics, DE&I). A literature review was completed to identify key milestone elements. Milestone was framed by ACGME core competencies (eg, MK, PC, SBP) and progression delineated across five levels. The 8-page milestone was iteratively revised by multiple stakeholders to 1-page suitable for inclusion as the end of each GME program’s required milestone assessment form.

Outcomes: Enthusiastic and pervasive support for the structural fluency milestone was achieved across the continuum. It was approved by GME Council for inclusion as a required formative milestone in every program. GME milestone data informs curriculum/instruction across the continuum (UME, GME, CME) using an expanded 2-page milestone for use as a blueprint at it retained each of the competency domains and references.

Innovation's strengths and limitations: Our milestone innovation recognizes need for data: to monitor our ability to learn/teach and ultimately eliminate racism (and other isms) and health disparities. Its strength is its limitation as we recognize it’s a journey and it will evolve as we do.

Feasibility and transferability for adoption: Formatted like existing ACGME milestones implementation within the assessment system was seamless enhancing its feasibility and transferability.