Associations of Internal Medicine Residency Ratings and Certification Examination Scores With Patient Outcomes—Reply

In Reply In response to the Letters about our recent article, we agree with Dr Brateanu and colleagues about the need for ongoing research assessing changes in milestone ratings, which were revised after our study period, and assessing the usefulness of ITEs. Similarly, the lack of granularity of milestone ratings may have contributed to their lack of associations with outcomes, which could be addressed by milestone updates. However, we found similar associations when applying more and less granular rating measures. Although aggregation across milestone ratings into a single measure may have masked underlying associations, examining associations with each of 22 individual subcompetency ratings resulted in similar findings.