Accreditation Council for Graduate Medical Education
Back to Orientation Introduction
Where do institutional and program requirements fit in?
The Accreditation Council for Graduate Medical Education is responsible for the Accreditation of post-MD medical training programs within the United States. Accreditation is accomplished through a peer review process and is based upon established standards and guidelines.
The Role of the ACGME
The Accreditation Council for Graduate Medical Education (ACGME) is a private professional organization responsible for the accreditation of nearly 7,800 residency education programs. Stakeholders of the ACGME's accreditation process are:
- residency programs
- their sponsoring institutions
- residents
- medical students
- the specialty boards of the American Board of Medical Specialties (ABMS)
- patients
- payers
- government
- the general public
Accreditation offers these stakeholders assurance that a given residency program and its sponsoring institutions meet an accepted set of educational standards.
The ACGME accredits residency programs in 110 specialty and subspecialty areas of medicine, including all programs leading to primary Board certification by the 24 member boards of the American Board of Medical Specialties, and completion of an ACGME-accredited residency program is a prerequisite for certification in a primary board. Completion of an ACGME-accredited subspecialty program is also required before an individual can sit for board certification in the majority of subspecialties.
The Accreditation Process
To develop and refine its accreditation standards and to review accredited programs for compliance with the standards, the ACGME relies on experts in the various medical specialties. Twenty-six specialty-specific committees, known as Residency Review Committees (RRCs), periodically revise the standards and review accredited programs in each specialty and its subspecialties. The process for periodically revising these standards includes solicitation of comment from interested parties and the public. The ACGME Board of Directors is ultimately responsible for standards revision and accreditation decisions.
To gain and maintain accreditation, residency programs are expected to comply with the Accreditation Standards for their discipline. In addition, institutions sponsoring residency programs are expected to adhere to a set of Institutional Requirements. Compliance with the ACGME's standards is measured through visits from RRCs. RRCs are heavily involved in the accreditation process. ACGME relies on experts in twenty-six specialties to revise the standard and review accredited programs. Accreditation typically occurs every 3-5 years, including both internal and external reviews. The membership of the RRCs is made up of physicians with reputations for expertise in residency education.
Organizations that appoint members to the RRCs include the:
- American Medical Association (AMA)
- The member boards of the American Board of Medical Specialties (ABMS).
- The academic specialty organization also appoints a portion of the RRC members.
A listing of all Accredited Programs and their accreditation status and time interval to the next site visit can be found on the ACGME Web site. For a more detailed discussion of the accreditation process, see the section on GME Useful Information at the ACGME website.
The Accreditation Site Visit
The formal periodic review of programs involves an on-site inspection, which is based on the Program Information Form (PIF), a comprehensive self-study document prepared by the program being reviewed. Each year approximately 2,000 programs are site visited by the members of the ACGME field staff, and around 150 programs are site visited by Specialist Site Visitors (SSVs). SSVs are volunteer experts who conduct a small number of site visits in their specialty during a given year. Members of the field staff are ACGME staff members. They are either physicians or individuals with a PhD or similar doctoral degree who are knowledgeable in the review of programs in all accredited specialties and subspecialties. In the ACGME's approach to accreditation, the site visitor is not the decision-maker regarding quality of a given educational program. Site visitors are fact-finders whose role is to verify and clarify the information provided in the Program Information Form (PIF). The PIF and the site visitor's report form the basis of the RRC's review and accreditation decision.
Prior to the site visit, the site visitor (field staff or SSV) is expected to have reviewed the self-study document prepared by the program, along with the Program Requirements and the Institutional Requirements governing accredited residencies. The site visit consists of interviews with the program director, members of the teaching faculty, residents, and often administrators and other key personnel. Following the visit, the site visitor composes an objective narrative report of the information that he or she collected during the interviews. This document is factual and non-judgmental, and reports omissions or discrepancies between the PIF and the information collected during the interviews. Site visitors are prohibited from making recommendations and from interjecting personal opinion into their reports. Their reports are intended to present the information gathered at the visit, without any effort to sway the Residency Review Committee for or against the program.
The ACGME Standards on Resident Duty Hours
In recent months, considerable public attention has focused on resident duty hours, and concerns about the impact of duty hours in the safety of patient care, resident learning, and the safety of the residents themselves. The ACGME is continuing its ongoing effort to refine its standards for resident duty hours, and to clarify the role of these standards in contributing to educational quality and patient and resident safety. Each ACGME-accredited specialty has requirements for duty hours .
Residency education has multiple goals that underlie the ACGME's standards:
- quality education
- safe and effective patient care
- and resident safety
Residency programs' efforts to safeguard residents against becoming exhausted while providing patient care involve more than attention to the number of duty hours. Supervision and back-up systems are also important in contributing to education, safe patient care, and resident safety. The ACGME has well-defined supervision standards, and its requirements stipulate that "programs must ensure that residents are provided appropriate backup support when patient care responsibilities are especially difficult and prolonged." The ACGME tracks compliance with its duty hour and related standards.
ACGME Staff
In order to carry out accreditation activities, the ACGME and its RRCs are supported by approximately 80 staff members. Approximately half of these serve the RRCs directly. Twenty-eight individuals are responsible for carrying out activities related to the accreditation site visit. Six individuals conduct research to advance the ACGME's accreditation activities. The remaining ACGME staff members perform various administrative and support functions.
21st Century Accreditation Activities
Under the direction of its Board and Executive Director, David Leach, MD, the ACGME has increased its efforts to assess and improve its accreditation effectiveness. The goal is to use state-of-the-art concepts from education and health care in the accreditation of residency programs. In the near future, health care will increasingly focus on the outcomes of care, and a concurrent movement within education has placed greater emphasis on educational outcomes. The ACGME's plan is to promote educational excellence in a changing health care environment through a focus on educational outcomes.
A major step in this area is the "Outcome Project," which has identified six general competencies important to the practice of medicine:
- patient care
- medical knowledge
- inter-personal and communication skills
- professionalism
- practice-based learning and improvement
- systems-based practice
The goal of the Outcome Project is to base programs' accreditation status on how well they educate residents and prepare them for the practice of medicine.
In summary, the role of the ACGME's accreditation activities is to promote the quality of residency education for the next generation of physicians, and to contribute to safe and effective patient care. The ACGME is committed fully to the task of improving the quality of resident education in the United States.
Program Requirements
Read your program's requirements. Go to the ACGME site and click on the "Program Requirements" link on the sidebar on the left side of the screen.
Go Ahead to Organizations: Residency Review Committees (RRC)
