1. Angela Buffington, PhD, MA
Milestone Evaluation of Physician-Patient Communication: Advances in the MERIT to Assess Resident Skill
Angela Buffington, PhD, MA
Erin Westfall, DO
Keith Stelter, MD, MMM

2. The Issue
ACGME Milestone Project gave educators a framework through which to assess development of resident physicians
Challenge: Educators are tasked with understanding Milestone language and application while simultaneously fostering skill development

3. Our Idea: Minnesota Evaluation of Relationship Interaction Tool (MERIT)
For competencies related to physician-patient communication
Tool to assess resident skill and enhance educational goals
Used while observing resident physician-patient encounters to track progress and set goals to improve communication

4. What we’ve done thus far
Milestones pertaining to physician-patient communication were embellished
Generated detailed behavioral anchors that indicate competency with a given Milestone
Exhibiting proficiency with these behavioral anchors then provides evidence that a resident is competent with a Milestone

5. The behavioral anchors
Taken from numerous existing scientific papers addressing physician communication
Motivational Interviewing PCOF AIDET 4 Habits
Kalamazoo Criteria CAT SPIKES Original
Revised which anchors fit best with which Milestone
Revised wording to be more user-friendly
Benefit of eliminating numeric ratings

6. Novel elements of MERIT
Created from Milestones (rather than fitting the Milestones into an existing tool)
Incorporates open-ended discussion questions
Includes encounter ratings by patient & resident
Can focus on one element of communication or the entire process

7. Where we’re at Done: Content validity
Used standards of assessment set by the ACGME
Behavioral anchors from existing measures and tools that pertain to physician communication
Face validity
Engaged multi-disciplinary faculty experts to select, align and judge behavioral anchors

8. Done:
Removed Level 1-5 labels so that MERIT is truly text based
Made behavior anchors chronological to follow flow of encounter
First attempt at electronic version

9. Next steps Inter-rater reliability
Multiple raters view several video recordings of resident-patient encounters
Target reliability is kappa ≥ 0.90
Electronic version
Getting the format to be most user friendly
Automating a Milestone report

10. Questions that remain
Does the MERIT give residents useful and relevant feedback?
Does the MERIT help faculty track resident progress on Milestones?
Will the MERIT improve efficiency of Clinical Competency Committee meetings?
Will the electronic version of the MERIT be user friendly?

11. References
The Accreditation Council for Graduate Medical Education and The American Board of Family Medicine (2013). The Family Medicine Milestone Project. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000). SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5, Mauksch L (2011). Patient Centered Observation Form. Miller, WR, & Rose, GS (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), Myerholtz L (2014). Assessing Family Medicine Residents’ Communication Skills From the Patient’s Perspective: Evaluating the Communication Assessment Tool. Journal of Graduate Medical Education, September, Peterson EB, Calhoun AW, Rider EA (2014). The reliability of a modified Kalamazoo Consensus Statement Checklist for assessing the communication skills of multidisciplinary clinicians in the simulated environment. Patient Education and Counseling, 96, 411–418. Stange KC (2009). A Science of Connectedness. Annals of Family Medicine, 7, Stein T, Frankel RM, Krupat E (2005). Enhancing clinician communication skills in a large healthcare organization: A longitudinal case study. Patient Education and Counseling, 58; 4–12.

12. @mnecw (Dr. Westfall); @UMNFamilyMed
University of Minnesota Family Medicine and Community Health