1. Angela Buffington, PhD, MA
Milestone Evaluation of Physician-Patient Communication: A New Tool to Assess Resident Skill
Angela Buffington, PhD, MA
Keith Stelter, MD, MMM
Erin Westfall, DO

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 the competency domain of 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
Each of the 4 Milestones pertaining to Communication was embellished
Generated detailed behavioral anchors that indicate mastery of a given Milestone skill
Exhibiting proficiency with a set of behavioral anchors provides evidence that a resident mastered a Milestone skill

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
“Communication is a fluid process. Thus, inherent to any rating tool is a risk of restricting the dialog.”
–CJ Peek
Incorporates open-ended discussion questions
Includes encounter ratings by patient & resident
Can focus on one skill 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. Next:
Inter-rater reliability
Multiple raters view several video recordings of resident-patient encounters
Target reliability is kappa ≥ 0.90

9. Questions that remain
Does the MERIT give residents useful and relevant feedback?
Does the MERIT help faculty track resident progress in the domain of Communication?
Will the MERIT improve efficiency of Clinical Competency Committee meetings?
Do we have the most relevant behavioral anchors for each Milestone?

10. 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.

11. @UMNFamilyMed
University of Minnesota Family Medicine and Community Health