Individual Milestone Data Consent

As part of our normal requirements for program improvement, UNC School of Medicine routinely seeks feedback on the performance of our graduates during their residency and/or fellowship education. To expedite some of this information gathering, the Accreditation Council for Graduate Medical Education (ACGME) has agreed to share certain information with UNC SOM about your residency experience only with your consent. In particular, we would receive information about the Milestones ratings of our graduates both individually and collectively. We would also see Milestones data aggregated from graduates of other programs across the country. Authorized members of our staff would use this information to identify areas for improvements in curriculum, learning experiences, and student advising. We would like to receive your identified Milestones ratings to help us improve our program. This would allow us to align this information with data we have about your medical school experience. We promise to treat your Milestones data with the same level of confidentiality and respect as we treat all of your other academic records in our possession. Under no circumstances will we divulge your Milestones ratings to any third party.

Please indicate whether or not you consent to the ACGME sharing this information with us.

YES, I consent to have my individual milestone data shared with UNC SOM

NO, I do not consent for individual data to be shared

PID

First Name

Last Name