Residency & The ACGME

What Is The ACGME?

The ACGME, or Accreditation Council for Graduate Medical Education, is a non-profit organization that accredits medical residency and fellowship programs in the United States. It sets standards for these programs, including requirements for patient care, supervision, and education, and conducts regular evaluations to ensure that programs are meeting these standards. This accreditation is necessary for programs to receive funding from the federal government and for residents to be able to participate in the National Resident Matching Program. The ACGME also provides resources and support to program directors and coordinators to help them maintain compliance with accreditation standards. 

The ACGME is governed by a Board of Directors, which is made up of a mix of representatives from the medical education community, the public, and the medical profession. The Board sets the overall policies and direction for the organization, and is responsible for appointing the President and CEO, who runs the day-to-day operations of the ACGME. The current President and CEO of the ACGME is Dr. Thomas Nasca.

The ACGME was formed in 1981 as a merger between two existing accrediting bodies: the Council on Medical Education of the American Medical Association and the American Medical Accreditation Program of the American Osteopathic Association.

This merger was the result of a long process of collaboration and negotiation between the two accrediting bodies, which began in the 1970s. Both organizations recognized the need for a unified and consistent approach to accrediting medical education programs, and worked together to create a new, independent accrediting body that would be responsible for accrediting both allopathic and osteopathic medical education programs.

The merger was approved by the membership of both the AMA and the AOA and the ACGME was formed as an independent, non-profit organization, governed by a board of directors representing the medical education community, the public, and the medical profession.

The ACGME receives funding from a variety of sources, including:

  1. Program fees: The ACGME charges fees to the medical residency and fellowship programs it accredits, which are used to cover the costs of accreditation activities such as site visits and evaluations.
  2. Sponsorship fees: The ACGME receives funding from organizations that sponsor accreditation programs, such as the American Board of Medical Specialties.
  3. Government grants: The ACGME may apply for and receive government grants to fund specific projects or initiatives related to medical education and accreditation.
  4. Investment income: The ACGME generates income from investments of its endowment and reserves.

The ACGME performs several other functions beyond accrediting medical residency and fellowship programs. Some of these include:

  1. Developing and updating standards for medical education programs: The ACGME sets standards for the content and structure of medical education programs, and regularly reviews and updates these standards to ensure they are current and relevant.
  2. Providing education and resources: The ACGME offers a variety of resources and educational materials to help program directors and coordinators understand and comply with accreditation standards, as well as to help residents and fellows learn and grow as physicians.
  3. Monitoring and enforcing compliance: The ACGME conducts regular evaluations of accredited programs to ensure they are meeting accreditation standards, and takes action when programs are found to be non-compliant.
  4. Supporting research and innovation: The ACGME encourages and supports research and innovation in medical education, and works to promote the integration of new technologies and methods into medical education programs.
  5. Collaborating with other organizations: The ACGME works closely with other organizations involved in medical education and accreditation, such as the American Board of Medical Specialties and the American Medical Association, to ensure a consistent and effective approach to medical education and accreditation.

ACGME Accredited Programs

Per the ACGME website, “During 2021-2022, there were 12,740 accredited programs, of which 5,579 were specialty programs and 7,161 were subspecialty programs. Additionally, 384 programs were newly accredited during the academic year. Forty-two programs closed or voluntarily withdrew their accreditation, and of these, 14 had one of the following actions: Accreditation Withdrawn or Administrative Withdrawal.” This represents 153,843 active residents and fellows in 12,740 programs.

For a medical residency or fellowship program to become accredited by the ACGME, the program must go through a process known as the “Initial Accreditation” process. This process involves the following steps:

  1. Application: The program applies for accreditation by submitting an application to the ACGME, along with documentation and other materials that demonstrate compliance with accreditation standards.
  2. Self-study: The program conducts a self-study, in which it evaluates its own compliance with accreditation standards and prepares a report that describes its policies, procedures, and practices.
  3. Site visit: The ACGME conducts a site visit to the program, during which a team of evaluators examines the program’s facilities, resources, and operations and interviews program leaders, faculty, and trainees.
  4. Decision: The ACGME reviews the program’s application, self-study report, and site visit report, and makes a decision about whether to grant accreditation.
  5. Monitoring: Once a program is accredited, it must go through regular evaluations to ensure that it continues to meet accreditation standards, and it must also report any significant changes to the program, such as changes in leadership or facilities.

Non-ACGME accredited programs are medical residency and fellowship programs that have not gone through the accreditation process with the Accreditation Council for Graduate Medical Education (ACGME) and are not subject to the ACGME’s standards and evaluations. These programs are typically found in non-traditional settings such as military hospitals, veterans hospitals, and some international hospitals. They may still be recognized by the American Medical Association (AMA) or the American Osteopathic Association (AOA), but they are not considered ACGME accredited.

It’s important to note that being ACGME accredited is not a guarantee of quality, but it indicates that a program has met certain standards and requirements set by the ACGME, which are considered as a minimum standard for quality in graduate medical education. Some non-ACGME programs may still provide high-quality education and training, but they may not be recognized by some medical boards or other organizations and may not be eligible for certain funding or other resources.

What Are The ACGME Core Competencies?

The ACGME has identified six core competencies that it considers essential for physicians in training to acquire. These competencies are:

  1. Patient care: The ability to provide safe, effective, patient-centered, timely, efficient, and equitable care.
  2. Medical knowledge: The ability to apply knowledge of biomedical, clinical, and population health sciences to patient care.
  3. Practice-based learning and improvement: The ability to investigate and evaluate one’s own patient care practices, appraise and assimilate scientific evidence, and improve patient care based on continual self-evaluation and life-long learning.
  4. Interpersonal and communication skills: The ability to effectively and compassionately communicate with patients, families, and healthcare professionals, and to work in interdisciplinary teams.
  5. Professionalism: The ability to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
  6. Systems-based practice: The ability to understand and use information systems, quality improvement, and patient safety principles, and to work effectively in healthcare systems to improve the care of individual patients and populations.

These competencies are intended to provide a framework for graduate medical education programs to design and implement their curriculum, evaluate the progress and performance of their trainees, and ensure that their graduates are prepared to deliver safe, high-quality care to their patients.

The ACGME does not test residents or fellows directly on the core competencies. Instead, it relies on the program’s evaluation system to ensure that residents and fellows are acquiring the competencies throughout their training.

The program’s evaluation system uses a variety of methods to assess residents’ and fellows’ progress, such as self-evaluation, evaluations by faculty and peers, evaluations of performance in the clinical setting, and standardized tests. The program’s evaluation system should also include regular feedback and opportunities for residents and fellows to reflect on their learning, and opportunities to address any identified gaps in their competencies.

The ACGME evaluates the program’s evaluation system during the accreditation process and through regular monitoring, to ensure that it is comprehensive, valid, and reliable, and that it provides evidence that residents and fellows are acquiring the core competencies.

It’s important to note that the ACGME also expects that the program will have a process in place to address any identified deficiencies in the residents’ or fellows’ competencies, through additional education, training, or remediation.

Quis custodiet ipsos custodes?

What Happens To A Program With Bad Scores?

If a medical residency or fellowship program reports poor scores on their evaluation system, the ACGME will take action to ensure that the program takes steps to address the issues and improve the quality of education and training provided to residents and fellows.

The ACGME uses a multi-level system for dealing with programs that have issues with compliance to its standards, starting with a warning letter and escalating to a probation or a revocation of accreditation.

The exact course of action taken by the ACGME will depend on the specific issues identified and the severity of the problems. In some cases, the ACGME may require the program to submit a plan for improvement, which must be reviewed and approved by the ACGME before it can be implemented. The program will then be closely monitored to ensure that the plan is being implemented effectively and that the issues are being addressed.

In more serious cases, the ACGME may place the program on probation, which means that the program is still accredited but must take additional steps to address the issues, such as additional site visits or evaluations. In the most severe cases, where the issues cannot be resolved, the ACGME may revoke the program’s accreditation, which means that the program can no longer participate in the Match and may lose funding from the federal government.

What Is A Site Visit?

You may have heard about the ACGME site visit from fellow residents, attendings or hospital staff. It is usually talked about in hushed tones, in back alleys, and almost always comes with grave warnings about the potential consequences. So what is it actually?

During an ACGME site visit, a team of evaluators visit the medical residency or fellowship program to assess whether the program is in compliance with accreditation standards.

The site visit team typically includes one or more physicians who are experienced in the specialty of the program being visited, as well as a lay person who represents the public. The team will visit the program’s facilities, review documents and other materials, and interview program leaders, faculty, and trainees.

The site visit team will also observe the program in action, including observing resident’s and fellow’s interactions with patients, faculty supervision and patient care, and other aspects of the program’s operations.

The team will then prepare a report, summarizing their findings and making recommendations for improvement, if necessary. The program will have an opportunity to review the report and provide feedback before the report is final.

The ACGME site visit is not a pass/fail process, but rather an evaluation process. The program’s compliance with standards is evaluated and the report is used to identify areas of strength and areas where the program needs to improve. The program will be expected to take actions to address any deficiencies identified in the report.

Does The ACGME Protect Residents?

Officially, yes, the ACGME is designed to protect residents. In practice, your mileage may vary. The ACGME has several official policies in place to protect residents during their training, including:

  1. Duty hours: The ACGME sets limits on the number of hours residents can work in a week, to ensure that they have adequate time for rest and education, and to reduce the risk of fatigue-related errors.
  2. Supervision: The ACGME requires that residents be supervised by faculty members who are appropriately trained and qualified, to ensure that residents receive appropriate guidance and feedback.
  3. Wellness: The ACGME encourages programs to promote the well-being of residents and fellows through providing resources and support for physical, emotional and mental well-being, which includes providing education and resources to help residents manage stress and promote self-care.
  4. Patient safety: The ACGME requires that programs promote patient safety, which includes providing education and training on patient safety and quality improvement, and ensuring that residents and fellows have access to the resources they need to provide safe and effective care.
  5. Compliance with laws and regulations: The ACGME requires that programs ensure that residents comply with all applicable laws and regulations, such as HIPAA and OSHA, and provide education and training on these topics.

With 12,740 programs and counting, it is easy to imagine there must be constant violations of these principles. So how does a resident or fellow go about reporting issues to the ACGME? The ACGME website provides an FAQ section for this exact topic, but we’ll summarize as well.

There are 2 ways to report issues to the ACGME:

  1. The Office of the Ombudsperson, which can be submitted anonymously. This report will not be shared with anyone in your program unless you specifically give permission to do so. Reporting of an issue through this channel could potentially lead to an internal inquiry for further investigation, but on its own cannot impact a program’s accreditation status. 
  2. The Office of Complaints, which cannot be submitted anonymously. The complainant’s name will not be shared with the program without permission or in cases of due process, but the complaint will be presented to the program in question. This formal complaint can impact a program’s accreditation status.

What is the process following a formal complaint? The DIO (Designated Institutional Official) and Program Director will be given an opportunity to respond. These responses will not be shared with the complainant. The ACGME Review Committee considers the allegations as well as the response and decides whether or not it warrants further investigation. Upon review, they may decide to inquire for more information, schedule a site visit, or close the investigation. You may be alerted to the status of your complaint, but no more information will be shared.

The ACGME’s official website also makes it clear that they will not help residents or fellows find another program and that you should simply contact your program’s HR department to deal with program related issues. 

Resources For Residents & Fellows

If some of the previous information seems a bit vague, know that you are not alone. Like many institutions, the ACGME is not necessarily designed to protect individuals over the systems that it governs. However, with so few resources available to current residents and fellows, leaning on the ACGME to affect change can be a powerful tool. You can report directly to the ACGME using this link.

ACGME Report

Know that the ‘multi-level system’ utilized by the ACGME to address program issues can be a long process and relies heavily on direct complaints and annual survey scores. Below is information about the annual survey and what you need to know.


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