Pomeranz H. ACGME Reviews Its Institutional Requirements. JAMA. 1998;279(23):1870Q. doi:10.1001/jama.279.23.1870
Edited by Ashish Bajaj, Department of Resident Physician Services,
American Medical Association.
A recent petition by resident physicians to the National Labor Relations
Board1 has raised the question, how well
are resident physicians represented in their residency programs? In response,
the American Medical Association (AMA) asked the Accreditation Council for
Graduate Medical Education (ACGME) to address this issue. Last week's Resident
Forum column discussed the ACGME's recent adoption of a "rapid response mechanism"
to deal with alleged egregious accreditation violations by residency programs.
The ACGME has also been reviewing its institutional requirements, which contains
the standards that each institution must meet in order to sponsor graduate
medical education (GME) programs.
The ACGME delegated consideration of this issue to its Institutional
Review Committee (IRC), which is charged with the review of institutions sponsoring
GME programs. The institutional requirements covers matters such as institutional
commitment to provide organizational and financial support for GME; the composition
and responsibilities of the institution's GME Committee, which oversees all
aspects of GME, including creation and review of all GME policies and procedures
and internal review of residency programs; quality assurance activities; resident
participation in education activities; resident financial support, benefits
and conditions of employment; and resident supervision, duty hours, and work
After considerable deliberation, the IRC proposed the following revisions
to the institutional requirements:
The GME Committee must include a resident physician as a voting
The GME Committee must ensure that an institution's educational
environment allows questions to be raised and resolved without fear of intimidation
or retaliation. This includes providing a formal communication system through
which residents can confidentially voice their concerns. This may be accomplished
through a resident or house staff organization or through other forums.
Institutions must enact fair policies and procedures regarding
the adjudication of resident grievances and regarding disciplinary actions
against residents that could result in dismissal or could significantly threaten
the resident's career development.
Each year, residents must be given the opportunity to submit to
program directors or other designated officials a confidential written evaluation
of faculty members and of their educational experience.
Residency programs must not require residents to sign a noncompetition
guarantee. For example, a program cannot limit the resident's ability to practice
within certain geographic boundaries after completing the residency program.
The institution's contract with the resident must contain or reference
provisions for financial support, vacation policies, professional liability
insurance, disability insurance, leave benefits, and counseling services.
It must also include policies regarding residents' responsibilities, professional
activities outside the education program (moonlighting), and grievance procedures.
These proposed revisions will be voted on at the ACGME's June meeting
and, if approved, will become effective July 1, 1998. We anticipate that the
revised requirements will encourage greater dialogue and resident involvement
with officials and faculty at their training institutions regarding patient
care and resident well-being. The AMA will continue to report on these matters
as they develop.