When the Accreditation Council for Graduate Medical Education (ACGME) asked residency programs to report their activities in of diversity, equity, and inclusion (DEI), family medicine (FM) program directors were unsure how to assess and evaluate their interventions. In 2020, the Association of Family Medicine Residency Directors’ (AFMRD) DEI and Health Equity committee responded with the creation of a tool, the AFMRD DEI Milestones.1 Residency programs can use these milestones for program assessment, goal setting, and progress tracking. The committee also surveyed FM residency programs on their DEI Milestones scores in 2022 and 2024. In both years, the survey indicated that, in aggregate, programs rated themselves highest in the curriculum milestone and lowest in the faculty and resident pathway milestones. In the second survey, questions were added to evaluate what resources programs utilized for DEI efforts. Additionally, feedback was collected throughout the time since publication on how programs could be better served by the milestones.2,3

Anecdotally, program directors expressed that the tool was useful for their Program Evaluation Committee for assessment and goal setting. It also provides, as intended, a structure for programs for their annual update to the ACGME. They also expressed mixed thoughts on how they could utilize the milestones as different states across the country restricted conversations about DEI efforts. As such, the AFMRD DEI and Health Equity committee used this feedback to update the milestones.

The DEI Milestones 2.0 now has greater consistency, indicating a progression for each of the areas across every milestone. They also worked to remove any possible assumption that these milestones were focused specifically on concerns of race and ethnicity and focus rather on ensuring an environment that is free from bias and in support of practices that are representative of the community. In the process of this revision, three members of the committee looked at each milestone to review for clarity, consistency in demonstrating growth across the milestone, and how each milestone represented increased knowledge in best practice for DEI recommendations. The entire committee then reviewed the revised milestones, providing more feedback, and the teams of three again updated the assigned milestone accordingly. The committee reviewed all the milestones one final time and then shared them at the Residency Leadership Conference in March 2025.

The initial intent was to present DEI Milestones 2.0 and resources that could be used when the program identified areas of opportunity with their assessments. However, the committee could not have predicted the impact that presidential executive orders would have on this plan. Instead, the presenters pivoted and offered an opportunity to share practices and challenges that programs were facing when supporting their residents, faculty, and curricula. This session at RLS proved to be both educational and inspiring. Family medicine educators continue to support this work, and clearly demonstrate a desire to identify tools to support programs, trainees, and faculty. The work that the committee has put towards these milestones also continues to remind residency educators of the foundational commitment that the ACGME has for the accreditation of programs and in setting standards for the learning environment that remains all encompassing. Following this, an additional presidential executive order has directly called into question the ACGME’s ability to hold programs and institutions accountable for DEI efforts. Regardless, as allowed under state and/or organizational policies, residency programs can continue to utilize these DEI Milestones to identify and address issues to improve the clinical learning environment. Efforts made with these milestones improve systems so that outcomes for patients, learners, and faculty, alike, improve.

On behalf of the AFRMD DEI and Health Equity committee, we share this updated resource list.