Assessment of Agenda Setting With ACGME Milestones in Family Medicine Residents

Background and Objectives: Family medicine residents are scored via milestones created by the Accreditation Council for Graduate Medical Education (ACGME) on various clinical domains, including communication. Communication involves a resident’s ability to set an agenda, but this is rarely taught in formal education. Our study aimed to examine the relationship between ACGME Milestone achievement and ability to set a visit agenda, as measured by direct observation (DO) forms. Methods: We examined biannual (December, June) ACGME scores for family medicine residents at an academic institution from 2015-2020. Using faculty DO scores, we rated residents on six items corresponding to agenda setting. We used Spearman and Pearson correlations and two-sample paired t tests to analyze results. Results: We analyzed a total of 246 ACGME scores and 215 DO forms. For first-year residents, we found significant, positive associations between agenda-setting and the total Milestone score (r(190)=.15, P=.034) in December, and in individual (r(190)=.17, P=.020) and total communication scores (r(186)=.16, P=.031), in June. However, for first-year residents, we found no significant correlations with communication scores in December or in the total milestone scores in June. We found significant progression for consecutive years in both communication milestones (t=-15.06, P<0.001) and agenda setting (t=-12.26, P<.001). Conclusions: The significant associations found in agenda setting with both ACGME total communication and Milestone scores for first-year residents only, suggests that agenda setting may be fundamental in early resident education.