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Putting the milestones to work: Applying the ABIM/ACGME milestones to assessment of agenda setting behavior.

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Mohamedy I. — Providence Saint Vincent's Medical Center

Merkel W. — Providence Portland Medical Center

Hardman J. — Oregon Health Sciences University

Smith S. — Boise Veterans Affairs Medical Center

Soung M, Bush R. — Virginia Mason Medical Center

Short P. — Madigan Army Medical Center

Potyk D. — Washington State University Spokane

Knight C. — University of Washington Medical Center

Caverzagie KJ. — Henry Ford Hospital

Hood S, Iobst W. — American Board of Internal Medicine

Presented: Association of Program Directors in Internal Medicine Meeting, April 2011

Background: A consortium of internal medicine residency program directors in the Pacific Northwest (PNW) studied how the internal medicine milestones can be used to assess the development of competency in graduate medical education.

Method: After initial organization in October 2007, the consortium met again in October 2008 and developed a draft assessment tool to assist faculty in evaluating residents' ability to set an agenda for an outpatient visit. The tool included a list of selected milestones from which faculty were asked to identify those that they directly observed. Eight programs in the PNW participated in the study, and data regarding time in academic practice, duration of observation, ability to provide feedback to the resident and time involved in giving feedback were also obtained.

Results: Over the course of a year, the consortium collected 68 responses from faculty at six internal medicine residency programs. The majority (64.7%) of faculty spent 10 or fewer minutes on the observation. Of those who used this opportunity to provide feedback to the resident, 90% spent five or fewer minutes on providing feedback. Of the 12 milestones initially identified by the consortium as likely to be evaluated during this focused observation (Patient Care=3, Medical Knowledge=1, Practice Based Learning and Improvement=1, Interpersonal and Communication Skills=3, Professionalism=4), eight milestones were evaluated by faculty in over 60% of the observations. Of these, five were evaluated in over 80% of observations. Many participants expressed satisfaction with the evaluation form, highlighting its usefulness for providing feedback on agenda setting to residents.

Discussion: This study highlights a successful example of using the milestones to develop an assessment tool that can inform the assessment and evaluation of resident competence in focused observations such as agenda setting at the beginning of an outpatient clinic visit. Faculty independently evaluated five of the available 12 milestones in over 80% observations, suggesting that milestones can guide focused assessment and evaluation of resident competency. Next steps for this initiative include the development of standardized videotaped encounters portraying different levels of agenda setting competency for use in faculty development.

For more information about this presentation, please contact Research@abim.org.