The Accreditation Council for Graduate Medical Education (ACGME) oversees residency training programs and training institutions in the United States. The ACGME sets requirements that institutions must meet in order to sponsor graduate medical education (GME). All residents should be familiar with these requirements because they are the "rules" of residency and contain many elements of protection and support for residents. This week's Resident Physician Forum will provide an overview of the requirements. The actual requirements will be listed and explained in a future column. The list of requirements is extensive and can be found on the ACGME's home page at http://www.acgme.org or in the AMA Graduate Medical Education Directory.
According to the institutional requirements, the purpose of GME is to "provide an organized educational program with guidance and supervision of the resident, facilitating the resident's professional and personal development while ensuring safe and appropriate care for patients." Training institutions, therefore, must be appropriately organized to conduct GME in a scholarly environment and be committed to excellence in both education and medical care. The institutional requirements, along with each specialty's program requirements, guide institutions and residency programs in the process of providing an ethical and professional environment in which the educational curricular requirements, as well as requirements for scholarly activity, can be met.
The institutional requirements contain stipulations as to what constitutes adequate financial support, insurance benefits, and working conditions for residents as well as specific policies regarding residents' responsibilities, professional activities, and grievance procedures. They define minimal competency standards for institutions participating in GME and provide protection for residents.
The ACGME assesses compliance with the requirements through its institutional review process. It delegates this process to the Institutional Review Committee, an independent committee that includes a resident member. The Institutional Review Committee examines periodic institutional reviews to determine compliance. Institutional reviews are conducted through correspondence with the institution and through a site visit. As part of the review, each institution must complete a checklist of requirements. An institution's failure to comply with the requirements could endanger the accreditation of all of its residency programs.
The institution is also expected to monitor its own compliance with the requirements. Each institution is required to have a GME committee that advises the institution on all aspects of residency education. The institutional requirements recommend that the GME committee or another designated body conduct regular internal reviews of all residency programs to assess their compliance with the requirements.
The institutional requirements are continually reviewed and revised with input from institutions, teaching physicians, and residents. If residents understand the institutional requirements, their contents, and the mechanism to alter them appropriately, they can ensure their long-term involvement in the process of graduate medical education and in maintaining its excellence.
