Diversity, Equity, and Inclusion Milestones: Creation of a Tool to Evaluate Graduate Medical Education Programs

Abstract

Background As the Accreditation Council for Graduate Medical Education (ACGME) began to ask programs to report their efforts surrounding diversity, equity, and inclusion (DEI), program directors felt ill prepared to evaluate their programs and measure change. Objective To develop a tool that would allow graduate medical education (GME) programs to evaluate the current state of DEI within their residencies, identify areas of need, and track progress; to evaluate feasibility of using this assessment method within family medicine training programs; and to analyze and report pilot data from implementation of these milestones within family medicine residency programs. Methods The Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed a tool for program DEI evaluation modeled after the ACGME Milestones. These milestones focus on DEI assessment in 5 key domains: Institution, Curriculum, Evaluation, Resident Personnel, and Faculty Personnel. After finalizing a draft, a pilot implementation of the milestones was conducted by a convenience sample of 10 AFMRD DHE Task Force members for their own programs. Results Scores varied widely across surveyed programs for all milestones. Highest average scores were seen for the Curriculum milestone (2.65) and the lowest for the Faculty Personnel milestone (2.0). Milestone assessments were completed within 10 to 40 minutes using various methods. Conclusions The AFMRD DEI Milestones were developed for program assessment, goal setting, and tracking of progress related to DEI within residency programs. The pilot implementation showed these milestones were easily used by family medicine faculty members in diverse settings.

Departmental Metrics to Guide Equity, Diversity, and Inclusion for Academic Family Medicine Departments

“…Measuring ultimate outcomes is challenging because convenient observables expressed in numbers are often not readily available. Many institutions have human 15 These highlight a five-level sequence of development for residents and faculty that spans the evolution from recruitment to leadership, the resident evaluation process, and the curriculum. Showing progress along this pathway could further support the EDI journey at your institution; for example, a shared metrics framework could be used during recruitment to inform prospective residents when ranking programs.…”

Integrating diversity into the medical curriculum

“…We can begin with the act of collecting data pertaining to students, faculty, and employees on a regular basis, and then classify them based on different parameters of diversity (19)(20)(21). At the same time, institutions can also run surveys to collect details from different stakeholders and their perceptions about the measures taken by the institution to ensure diversity (22). We must organize periodic reviews of admission practices in the institution and look for the practices that have been adopted for the same (in terms of whether there is a scope for bias or whether specific measures have been taken to promote diversity, etc.)…”

“…We can also measure the inclusivity of the learning environment by analyzing the presence of inclusive practices (with regard to teaching-learning -like being relevant to students with different learning styles; assessment; student support services, etc.) in the medical curriculum (19,22,25). Another effective strategy to measure diversity can be in the form of comparing the diversity metrics of one college with other medical colleges and accordingly learning from each other (best practices) (25).…”

Eligible Applicants and Diversity Across Settings in a Regional Family Medicine Residency Network

“…A first step for programs to address DEI and aim for a diverse body of residents that more closely matches their patient population and local needs is having access to data that can help identify opportunities to increase diversity, identify points of bias, and track progress over time. The 2022 AFMRD DHE Committee diversity milestones, which offer a familiar structure to residency program directors for evaluating their organizational efforts in DEI, 11 detail DEI efforts in recruitment at Level 1: “Data tracking of diversity of applicants to program, holistic review of applicants, best practices to reduce bias in interview and rank process, integration and recognition of systemic oppression in rank process.” 12 Although access to demographic data is increasing nationally, there is a lack of data specific to family medicine graduate medical education. The Association of American Medical Colleges (AAMC) has been collecting data for decades on medical student diversity (gender, racial, and ethnic identification) allowing for comparisons over time.…”