An ACGME Primer: What Every Resident (and Faculty Member) Should Know

Maggie A. Jeffries, M.D., RRC Representative
ASA Resident Component

“ACGME” is a term often used within residency circles. So what is the ACGME?

For starters, ACGME stands for the Accreditation Council for Graduate Medical Education. Founded in 1981 as a private, nonprofit organization, ACGME accredits graduate medical education programs and sponsoring institutions. It is located in Chicago and governed by a board of directors. The board is composed of four representatives each from the Association of American Medical Colleges (AAMC), the American Board of Medical Specialties (ABMS), the American Hospital Association (AHA), the American Medical Association (AMA) and the Council of Medical Specialty Societies (CMSS). In addition there are two resident members, three public members, one federal representative and one chair of the Council of Review Committee Chairs as well as numerous standing and ad hoc committees. A review committee, or RC (formerly known as a residency review committee, or RRC), is specialty-specific and in anesthesiology is composed of nine volunteer physicians representing ASA, AMA and the American Board of Anesthesiology (ABA), one resident member and various ex-officio members.

O.K., so enough with the details and boring abbreviations. What does ACGME do?

Specifically, ACGME accredits programs, sets standards for graduate medical education, collects case log data, monitors duty hours, conducts resident surveys and responds to unique resident complaints. The mission of ACGME is to “improve healthcare by assessing and advancing the quality of resident education through accreditation.” On average, each anesthesia program is examined every 3.5 years (range one to five), a process that involves an on-site inspection. The site visitor is employed by ACGME but is not a member of the RC and does not have input on accreditation decisions. This person’s primary responsibility is to verify that the information submitted by the program is accurate as perceived by the faculty, trainees and institution leaders. Most residents will encounter an ACGME site visitor during their residency years, an experience that should be educational and nonthreatening. In order to make an accreditation decision, the RC examines the information submitted by the program, accreditation history of the program, site visitor’s report, resident survey and average board pass rate. Why the pass rate? ACGME anticipates that a minimum of 70 percent of any program’s graduates will become certified by an ABMS board (the ABA in our specialty) within five years of graduation. It is just one of many bits of information that reflects the quality of a program and its trainees.

No doubt you are now thinking, “What is accreditation, and is that the same as board certification?” Accreditation is a voluntary process of evaluation and review performed by a nongovernmental agency of peers. ACGME accredits residency programs.

In contrast ABA certification is the process that provides assurance to the public that an individual, in this case a board-certified anesthesiologist, has successfully completed an accredited educational program and a series of evaluations. ABA certifies individuals. These processes are complementary to one another. ABA and ACGME often work together, but their processes remain separate and distinct.

Why is it important to know more about ACGME? After spending two years on the anesthesiology RC as the resident member, I can assure you that it is paramount that all residents and faculty are aware of and stay current on the activities and deliberations of ACGME. Specific to our specialty, new program requirements are constantly being updated for both core anesthesiology and subspecialty training. Several examples follow. As of February 2007, many programs applied and have received accreditation for the newly recognized cardiothoracic anesthesia subspecialty. Multidisciplinary pain requirements have taken effect in July 2007, with major changes being implemented in the pain curriculum. In July 2008, major curriculum changes to the core anesthesia requirements will take effect. The anesthesiology RC has a Web page within the ACGME Web site, and it would be a great idea to bookmark it: www.acgme.org/acWebsite/navPages/nav_040.asp. On this site, you can find program requirements, a biannual newsletter, recently updated frequently asked questions and program information forms (also known as a “PIF” — a lot like the Internal Revenue Service’s 1040).

ACGME committees other than its RCs also are very active. One area being investigated is the development of an electronic, competency-based resident portfolio that is Web-accessible. There is a Committee on Innovation in the Learning Environment, or CILE, that is working to define resident and fellow learning environments and explore ways to enhance them. One topic being considered by this committee is the relationship between duty hours and the success of the learning environment. The ACGME’s Outcome Project, started in 1998, is a long-term initiative designed to increase outcome assessment in residency programs and accreditation. It prompted the development of the general competencies and educational outcome assessments that are used today.

I write this article in hopes that it reaches many residents and academic faculty members who are impacted by resident education. As physicians we are very busy and may not be current on the issues affecting resident education. Even with widespread use of the Internet and e-mail, communication remains difficult. Electronic media is now the primary vehicle for communication, but our “Inbox” is constantly bombarded, making novel approaches important. Fortunately both ACGME and the anesthesiology RC are trying! Call-room posters directing residents to the ACGME Web site were distributed to programs in 2006. An online “Resident Review” letter addressing resident issues is available semiannually; it is used to educate residents on ACGME processes and definitions and keep residents current on ACGME initiatives.

The time has come for another anesthesiologist-in-training to seek appointment to the anesthesiology RC. This person will be nominated by the ASA Resident Component Governing Council and approved by the ASA Board of Directors. Increasing awareness and education about ACGME will be one of the challenges that the next resident member of the RC will face. He or she will assume this responsibility in a very exciting time, with many educational initiatives and other projects coming to fruition. Working with and learning from leaders in anesthesia education is an experience that has been awe-inspiring. It is time for the next resident member to take a place on the RC and influence the future of resident education. It is a truly rewarding experience.

Maggie A. Jeffries, M.D. is an instructor at M. D. Anderson Cancer Center, Department of Anesthesiology and Pain Medicine, Houston, Texas.