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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.

Introduction: The Objective Structured Clinical Examination (OSCE) is utilized by medical schools to assess students' competency in clinical skills. Literature has shown that first-year students who were tutored by fourth-year students (MS4s; near-peer) in practice OSCEs reported self-perceived improvement in OSCE skills. There is a lack of research regarding the effectiveness of first-year (MS1) pairs for reciprocal-peer practice OSCEs. This study aims to assess if virtual reciprocal-peer OSCEs provide comparable learning opportunities to virtual near-peer OSCEs.Methods: MS1 students were assigned to work with a near-peer or a reciprocal-peer for one week, and then switched protocols the second week. One student in each reciprocal-peer pair was assigned to act as a standardized patient (SP). Their partner took a history, interpreted physical exam findings, prepared a note, and gave an oral presentation. The pair then switched roles using a second case. The near-peer group followed the same procedure, without the reversal of roles.Results: A total of 135 MS1s participated in the first week and 129 in the second week. Students agreed that working with a near-peer was more valuable than a reciprocal-peer in the following parameters: peer feedback (N=113, 89%), history-taking skills (N=101, 80%), physical exam skills (N=102, 81%), and notewriting skills (N=109, 89%). Pairwise comparison utilizing Wilcoxon signed-rank test indicated participants preferred the choice of a fourth-year student partner over an MS1 partner (Z=1.436, p<0.001).Conclusion: Participants found working with a near-peer increased confidence in their clinical skills and near-peer feedback was more valuable. Although MS1s found that watching and evaluating their peers in a reciprocal-peer exercise was beneficial, students overwhelmingly preferred working with MS4s due to more valuable feedback.

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