November 2001
Volume 65 |
Number 11
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RESIDENTS'
REVIEW
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| What Is ACGME and What Is
Its Role in Residency Education? |
Carlos L. Moreno, M.D., Chair
Resident Component Governing Council
Upon graduation from medical school, I recall hearing for the first
time a reference to the Accreditation Council for Graduate Medical
Education (ACGME). I remember wondering what this national organization
had to do with my residency training. Since then, I have become
enlightened as to their function. I would like to share some information
that describes what ACGME is and what role it plays in our residency
training.
The ACGME is a private, professional organization responsible
for the accreditation of nearly 8,000 residency education programs
nationwide. It is one of the largest private accrediting agencies
in the country, if not the world. Residency programs, their sponsoring
institutions, residents, medical students, the specialty boards
of the American Board of Medical Specialties (ABMS), patients,
payers, government and the general public have a vested interest
in ACGME’s accreditation process. Accreditation offers these
interested parties assurance that a given residency program and
its sponsoring institutions meet an accepted set of educational
standards.
ACGME accredits residency programs in 110 specialty/subspecialty
areas of medicine in addition to all programs leading to primary
board certification. Completion of an ACGME-accredited residency
program is a prerequisite for certification in a primary board.
Completion of an ACGME-accredited subspecialty program is required
before an individual can sit for board certification in the majority
of subspecialties. ACGME does not accredit training in combined
programs (i.e., internal medicine-pediatrics or internal medicine-psychiatry).
ACGME relies on experts in the various medical specialties to
develop its accreditation standards. Twenty-six specialty-specific
committees, known as Residency Review Committees (RRCs), periodically
revise the standards and review accredited programs in each specialty/subspecialty.
Residency programs are expected to comply with the accreditation
standards for their discipline in order to obtain and maintain
accreditation. In addition, institutions sponsoring residency
programs are expected to comply with a set of institutional requirements.
The RRC contacts for anesthesiology are:
Executive Director Judith S. Armbruster, Ph.D. (312) 464-4642,
<jsa@acgme.org>; Associate
Executive Director Linda Thorsen (312) 464-5366, <lmt@acgme.org>;
Accreditation Administrator Dawn Foster (312) 464-4645, <dfoster@acgme.org>;
Senior Secretary Betty Cervantes (312) 464-4644, <bac@acgme.org>.
Compliance with ACGME’s standards is measured through periodic
review of all programs. Each accredited residency program is site-visited
every 3.7 years. The interval between site visits ranges from
one to five years. Programs that have demonstrated compliance
with the accreditation standards receive full accreditation. If
a program is found to have deficiencies, ACGME lists these as
specific citations in its accreditation letter to the program
and expects the program to come into compliance. If a program
has significant deficiencies, it may be given a warning or placed
on probation. The intent is to alert the program and its sponsoring
institution to the need for improvement in the areas identified
as deficient or face more serious action by ACGME. Ultimately,
programs that fail to comply with the standards have their accreditation
withdrawn. It is rare that a program’s accreditation is withdrawn
because of failure to comply with a single standard, but this
can occur for very serious deficiencies. ACGME’s actions
in establishing standards and in withdrawing the accreditation
of programs that fail to demonstrate compliance have been affirmed
by several court decisions.
Complaints specifically related to alleged noncompliance of institutional
and program requirements (see <www.acgme.org> for specific
institutional/program requirements) may be made by anyone associated
with a residency program, such as a resident or a staff member
or by anyone who has knowledge of the residency program. Those
wishing to submit a complaint alleging noncompliance with requirements
should identify the specific requirements with which there is
alleged noncompliance. It should be clearly understood that ACGME
and its review committees will not adjudicate individual disputes
between persons and residency programs. Residents who are involved
in disputes with a program regarding promotion, nonrenewal of
contract or dismissal, sexual harassment or discrimination should
refer to their institution’s formal grievance procedures
and familiarize themselves with the ACGME institutional requirements.
If the sponsoring institution lacks grievance procedures described
in the institutional requirements, use of these ACGME complaint
procedures may be appropriate.
Residents also may contact any of the national resident physician
organizations, including those of the American Medical Association,
Association of the American Medical Colleges, Council of Medical
Specialty Societies, National Medical Association, Bureau of Health
Professions (Consortium of Resident Specialty Groups) or their
specialty for advice. If appropriate, they may choose to seek
legal counsel. Persons having evidence of noncompliance with requirements
should be aware of the options available to them for expressing
concern either as an individual or as a member of a group. These
options are listed below in the recommended order in which they
should be utilized depending on the complainant’s relationship
to the program:
1. Contact the program director to try to resolve the issue
2. Inform the graduate medical education committee of the sponsoring
organization
3. Contact the resident organization of the institution, if
one exists, or the appropriate institutional forum or individual
appointed to address resident concerns as outlined in the institutional
requirements
4. Send a signed, written communication to the executive director
of the appropriate review committee as listed on the ACGME Web
site.
All communications to the ACGME regarding alleged noncompliance
with ACGME institutional and/or program requirements must be signed
by the complainant and be addressed to the executive director
of the appropriate review committee at 515 N. State Street, Suite
2000, Chicago, IL 60610.
Anonymous complaints will not be considered by ACGME. Failure
of the program or institution to comply with ACGME institutional
and/or program requirements must be documented and specific details
provided. This must include reference to the program and/or the
institutional requirements allegedly being violated and documentation
supporting the complaint and a statement of the steps that were
taken in an attempt to resolve the issues within the institution
and the results of those efforts.
At the discretion of the executive director, a complaint may
be brought to the attention of a review committee, the program
director and/or others outside ACGME without revealing the name
of the complainant. If the executive director decides that the
issues or incidents involved require the disclosure of the name
of the complainant to a review committee, a program director and/or
others outside ACGME, he/she will be so informed, and written
authorization to use his/her name will be requested. A complainant’s
name will not be disclosed to any party without written consent.
The executive director will notify the complainant whether the
complaint falls within the scope of these procedures and, if so,
how it will be processed. If the criticisms are vague as to the
situation that constitutes alleged noncompliance, the executive
director will ask the complainant to provide more specific information.
If the complaint does not fall within the scope of these procedures,
the complainant will be so informed and no further action will
be taken. If the complaint is considered valid, the issues of
noncompliance outlined in it may be dealt with as part of the
next scheduled review of the program or be brought to the attention
of a review committee at one of its regular meetings. The executive
director in consultation with the chair of the review committee
will determine if the complaint has validity. If it is determined
that the complaint should be brought to the attention of the review
committee prior to the next scheduled survey of the program, the
executive director will inform the program director and/or the
designated institutional official for graduate medical education
of the complaint and request a written response. This response
must be co-signed by the corporate executive officer of the sponsoring
institution and by the designated institutional official.
After receiving the written response of the program director
and/or the designated institutional official, the executive director
will forward the case to the review committee. The review committee
may exercise the following options:
a. The review committee may conclude that no action on the
complaint is warranted. The complainant, program director and/or
the designated institutional official will be so advised.
b. The review committee may decide to investigate the issues
raised in the complaint through a site visit that will be scheduled
immediately or during the next regularly scheduled site visit
and review. The complainant, program director and/or the designated
institutional official will be informed of the decision.
c. The residency review committee that has handled a complaint
against a particular program may notify the ACGME Institutional
Review committee for further investigation at the institutional
level.
In conclusion, the mission of ACGME’s accreditation activities
is to improve the quality of residency education while establishing
safe and effective patient care guidelines for residency training
programs. I hope that by sharing this information, anesthesiology
residents nationwide are better informed of how ACGME influences
their residency training and what options are available to residents
if questions, issues or concerns are raised regarding individual
residency training programs.
Source:
1. Accreditation Council for Graduate Medical Education <www.acgme.org>.
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Carlos L. Moreno,
M.D., is a CA-3 resident at the University of Michigan, Ann
Arbor, Michigan. |
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