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Resident Physician Forum
July 28, 1999

The Requirements of Residency: Educational Administration and Internal Reviews

JAMA. 1999;282(4):308E. doi:10.1001/jama.282.4.308

The last 3 Resident Physician Forum columns explained the requirements set by the Accreditation Council for Graduate Medical Education (ACGME) regarding compensation, fringe benefits, contracts, work hours, supervision, and other aspects of the work environment that apply to all institutions that train resident physicians. In addition to these institutional requirements, each residency program must adhere to the program requirements set by its Residency Review Committee. This column presents some of the requirements regarding the educational oversight of programs. Next week's column will present the requirements regarding communication between residents and the institution's administration.

Educational Administration

Every institution must provide an organized administrative system that oversees all residency programs. The institution must designate an official who oversees and administers these programs.

The institution must establish a graduate medical education committee (GMEC) that monitors and advises the institution on all aspects of residency education. The voting members of the committee must include program directors, other faculty members, other accountable institutional officials, and at least 1 peer-nominated resident. The committee must meet at least quarterly and keep minutes. The committee is responsible for the following:

  • Creation and implementation of policies that affect all residency programs regarding the quality of education and the work environment for the residents in each program.

  • Appropriate oversight of, and liaison with, the directors of each residency program. The GMEC must also help ensure that the program directors communicate effectively with personnel at any other hospitals or training sites to which the residents are assigned to serve.

Internal Reviews

The GMEC is also responsible for ensuring that a regular review of each of the institution's residency programs is conducted to assess compliance with the institutional and program requirements. The reviewers should include faculty, residents, and administrators who are selected from both within and outside the department in which the residency exists. External reviewers may also be called in if the GMEC so decides. The review must follow a written protocol approved by the GMEC. This review should appraise:

  • The educational objectives of each program and the adequacy of available educational/financial resources to meet these objectives.

  • The effectiveness of each program in meeting its objectives.

  • The effectiveness in addressing citations from previous ACGME letters of accreditation and previous internal reviews.

The internal review can use data from the institutional and program requirements, letters of accreditation from previous ACGME reviews, reports from previous internal reviews, and interviews with the program director, faculty, residents in the program, and individuals outside the program deemed appropriate by the committee. Finally, the review must be documented and the mechanisms to correct any identified deficiencies must be recorded.