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What every medical student needs to know about the ACGME

Have lots of questions about residency? What sort of requirements do residency programs have to meet to be accredited? How do you know if a residency program is accredited? What does accreditation mean?

Welcome to the Web site of the Accreditation Council for Graduate Medical Education (ACGME). You have just logged on to an information site that will be extremely helpful as you look ahead to residency training. The ACGME is a private, non-profit organization that accredits all the allopathic residency programs in the United States and promotes quality education for residents. Attaining accreditation from the ACGME signifies a program’s commitment to achieving and maintaining quality education for residents and safe care for patients.

What is graduate medical education?

GME is simply the clinical training that follows graduation from medical school (undergraduate medical education); i.e. residency and fellowship.

What is accreditation?

Accreditation is a voluntary process of evaluation and review performed by the ACGME. The goals of accreditation are to evaluate, improve and publicly recognize graduate medical education programs that meet or exceed ACGME standards. Most medical and surgical specialty boards require physicians to complete an ACGME-accredited residency training program to be eligible for specialty certification. In addition, programs must be ACGME-accredited in order to receive federal graduate medical education funds.

What is the ACGME?

The ACGME is a private, non-profit professional organization that accredits about 8,000 residency education programs in the United States educating more than 100,000 residents. Its mission is to improve the quality of heath care in the United States by ensuring and improving the quality of graduate medical education for physicians. The ACGME is governed by a 27-member Board of Directors, which includes 20 directors appointed by the member organizations of the ACGME, three public directors, two residents, the chair of the Council of Review Committee Chairs and a non-voting federal government representative. The ACGME member organizations are the American Association of Medical Colleges, American Board of Medical Specialties, American Hospital Association, American Medical Association, and Council of Medical Specialty Societies.

What are the major interests of the ACGME?
  • Residents
  • Curricula and standards for resident education
  • Support of the program directors and faculty who teach residents
  • Patient and resident safety
  • Learning environments
  • Institutions that are appropriate for graduate medical education
  • Chronically troubled institutions that need help with graduate medical education

What are the goals of the ACGME?
  • To establish the educational standards of graduate medical education
  • To evaluate the quality of medical education programs
  • To strive to improve evaluation methods and processes
  • To promote effective measurement tools to assess resident physician competency
  • To encourage educational improvement

What is an RRC?

Each medical or surgical specialty discipline has an ACGME Residency Review Committee (RRC), composed of physicians nominated by supporting organizations (e.g. AMA, medical specialty boards, professional organizations) as well as one or more resident representatives. The RRCs establish program requirements and make accreditation decisions for programs in that specialty and related subspecialties.

Who sets the standards for residency education?

The ACGME sets common program requirements for all residency programs, and individual RRCs augment these with additional specialty-specific program requirements and guidelines that residency programs must meet to receive and maintain accreditation.

What do program requirements cover?

The program requirements encompass program goals and objectives; required curriculum; program director and faculty qualifications and responsibilities; facilities; duty hours and call; outpatient, inpatient, and surgical experience; resident research; resident evaluations; board examination passing rates; and many other topics. Program requirements for all specialties are posted on the ACGME Web site

How does a residency program become accredited?

New programs submit an application and undergo an evaluation by an ACGME site visitor, who is considered the eyes and ears of the ACGME. The appropriate RRC reviews the site visitor’s report, as well as data submitted by the program director in a program information form (PIF), and makes an accreditation decision based on that information. After the initial accreditation, each program is reviewed every one to five years as determined by the RRC based on the strength of the program. For each review, programs must complete a lengthy set of documents to demonstrate compliance with the program requirements and undergo a site visit, which includes face-to-face interviews with residents. In most cases, residents will be asked to complete a confidential online survey to determine the program’s compliance with duty hour regulations and other policies.

Accreditation is granted to a residency training program that is in compliance with the program requirements at the time of the site visit, has successfully addressed all past citations, and, in the opinion of the RRC, meets the criteria and standards for the specialty.

Are fellowship programs also accredited by the ACGME?

Some fellowship disciplines are accredited by the ACGME, but many subspecialty fellowship disciplines are not.

What are the accreditation categories?

A new program is granted initial accreditation if the RRC determines it substantially complies with the requirements. Continued accreditation is granted when the RRC determines that an established program has demonstrated substantial compliance with the requirements. Typically, the maximum length of a review cycle granted by an RRC is five years.

Programs that are not in substantial compliance with program requirements may be given probationary accreditation. All residents must be notified if their program is placed on probation. The program director must also inform all medical student applicants that the program is on probation. Probation is considered an accreditation status. (A list of programs on probation is posted on the ACGME Web site.) The review cycle length for programs with probationary accreditation cannot exceed two years.

Programs with probationary accreditation that fail to demonstrate substantial compliance with requirements may have their accreditation withdrawn. All candidates to the program and residents in the program must be notified in writing of the RRC’s decision to withdraw accreditation.

Regardless of a program’s accreditation status, an RRC following a site visit and review may withdraw a program’s accreditation in an expedited process when there is a catastrophic loss of resources (faculty, facilities, funding) or the RRC determines there is egregious noncompliance with accreditation requirements.

How can medical students find out the accreditation statuses of programs?

The accreditation statuses of programs are posted on the ACGME Web site along with basic information about the programs the name of the program director, number of residents, name and address of the sponsoring institution, names of participating institutions, date of the most recent site visit and approximate date for the next site visit.

How can I find out if a program I’m interested in is on probation?

The ACGME posts a list of the programs on probation. Log on to the ACGME Web site, click on “Search Programs/Sponsors” and then click on “Unfavorable Decisions.”

Do programs ever close?

Yes, programs do close for a variety of reasons. Although institutions are ultimately responsible for placement of residents, the RRCs actively assist in the process to help residents to complete their education

Whom can I talk to at the ACGME if I have questions?

Each RRC has an executive director who is a full-time ACGME staff member. RRC executive directors and their support staff are available by phone or e-mail. Staff lists for each RRC are posted on the RRC pages, as well as on the staff list page.

Does the ACGME handle complaints against programs?

Residents can file complaints about program non-compliance with requirements or issues of due process with the ACGME complaint officer. The ACGME will not consider anonymous complaints. If the complaint is serious enough to warrant investigation, the complainant must reveal his or her identity to the ACGME. The ACGME keeps the identity of complaints confidential except in cases where there is a risk of harm to the program director, patients, staff or the complainant. In those instances the program director must be alerted.

Is the ACGME involved in competency-based education?

Yes. In 2002, the ACGME launched its competency initiative, which is called the Outcome Project. The ACGME identified six general competencies patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal skills and communication, and systems-based practice – which are now part of the curriculum in every program. The program director and faculty evaluate residents using the competencies as criteria. In addition, some medical school evaluations and all specialty certifications are also being reorganized into the competencies framework. More information is available on the Outcome Project page on the ACGME Web site.

What about duty hours?

On July 1, 2003, all ACGME-accredited programs had to be in compliance with the ACGME’s common duty hour standards. The standards include an 80-hour weekly limit on duty hours, averaged over four weeks; one day in seven free from patient care and educational obligations; and a 24-hour limit on continuous duty with up to six added hours for continuity of care and education. Some RRCs have additional duty hour limits for programs in their specialties and subspecialties.

The ACGME requires program directors to submit documentation on compliance with the duty hour standards. In addition, the ACGME gathers information on duty hour compliance and other issues through an annual confidential Internet survey of residents. The ACGME takes the duty hour standards very seriously, and programs that violate the standards face adverse accreditation actions up to withdrawal of accreditation.

What is the address and phone number of the ACGME?

Accreditation Council for Graduate Medical Education
515 North State Street, Suite 2000,
Chicago, Illinois 60654
312.755.7498 (fax)