Institutional Requirements
Article Outline
- The Role of the Sponsoring Institution in GME
- The GME Official and Committee
- Responsibilities of the Institution to Residents
- Summary
- References
- Copyright
Sponsoring institutions are ultimately responsible for the graduate medical education (GME) that takes place in every department within the institution. While each department's GME program is guided by the program requirements approved by the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) for that specialty, the institution is guided by the ACGME's institutional requirements. According to these requirements, the sponsoring institution should conduct GME in a scholarly environment, be committed to excellence in education and medical care, be in substantial compliance with the institutional requirements, and enable each department to achieve compliance with program requirements. The latest version of the institutional requirements, effective July 1, 2002, also requires that the institution provide an environment in which the general competencies can be met (1). The institutional requirements are also available at the ACGME Web site, www.acgme.org, in the section on “GME Useful Information.”
The Role of the Sponsoring Institution in GME
Each ACGME-accredited residency program must operate under the authority and control of a sponsoring institution, which must have a written statement of commitment to GME that is supported by the administration, teaching faculty, and staff. All sponsoring institutions must be accredited by the Joint Commission on the Accreditation of Healthcare Organizations, if eligible, or by another recognized accrediting body.
The institution is ultimately responsible for ensuring that its ACGME-accredited residency programs are in compliance with the program requirements and the applicable institutional requirements. Just as residency programs must undergo periodic review and site visits, the institution is required to submit documentation to the ACGME and allow site inspection on a regular basis (2). If an institution does not comply, the accreditation of all of its sponsored residency programs may be jeopardized. Therefore, it is very important that there be a close working relationship between each department and the institutional officials in charge of GME.
The GME Official and Committee
The institution must designate an official to oversee and administer GME programs. This person must maintain open communication with all of the program directors, faculty, and residents within the institution. There must be a GME committee with responsibility for monitoring and advising on all aspects of resident education. The committee should consist of the institutional GME official(s), program directors, other members of the faculty, and residents nominated by their peers. It must meet at least quarterly, and minutes of the meetings must be distributed to all members. These quarterly meetings can be extremely valuable for providing program directors with guidance on residency issues and updates on new requirements. If the residency program director cannot attend the meetings, it is advisable to have a representative attend and report back on them. At the very least, the program director should read the minutes of a missed meeting.
The institutional GME committee has several responsibilities designated in the institutional requirements. First, it must establish and implement policies regarding the quality of education and work environment for residents in each program. It must also oversee and communicate with program directors to ensure that they maintain proper oversight and communication with appropriate personnel of other institutions that may be participating in their department's resident education program. The committee is to review all of the ACGME letters of accreditation and to monitor action plans for correction of areas of noncompliance. It is also required to ensure that each residency program in the institution establishes and implements formal written criteria and processes for the selection, evaluation, promotion, and dismissal of residents in compliance with ACGME institutional and program requirements.
One of the most important activities of the GME committee is the internal review of each residency program. These reviews are to take place at approximately the midpoint between ACGME program surveys, when the program can be evaluated for compliance with all regulations and correct any deficiencies well before the next ACGME site visit. The internal review should be conducted by a committee consisting of faculty, residents, and program administrators within the institution who are not members of the department under evaluation. The internal review committee assesses all aspects of the program's written documentation and interviews members of the program's faculty and residents. Figure 1 lists the specific items evaluated in internal reviews. Each internal review culminates in a written report that is reviewed by the GME committee and given to the department for correction of areas of noncompliance.
Figure 1.
Items evaluated in internal reviews. (Adapted from reference 1.)
Responsibilities of the Institution to Residents
An important function of the institution is to provide a buffer between the residents and the departmental administration of their training program. This allows residents to raise and resolve issues regarding their training without fear of reprisal. The institution must provide a structure whereby residents can voice concerns or questions about their working environment and educational programs both confidentially and safely. This is often done by mean of a “residents' forum” where resident representatives from each department, elected by their peers, meet to discuss issues related to all aspects of their training. The GME committee is also charged with establishing and implementing fair institutional policies and procedures for disciplinary actions against residents. The committee must provide a system for “adjudication of resident complaints and grievances related to actions that could result in dismissal, nonrenewal of a resident's contract, or other actions that could significantly threaten a resident's intended career development” (1).
The institution is required to make recommendations and oversee global issues such as funding for resident positions in each department, implementing of work duty hours guidelines, and ensuring that each program has a valid curriculum and evaluation system in place. Because of recent controversies and press coverage of the problems associated with fatigue from long work hours, the ACGME has developed new on-duty hours requirements that will go into effect on July 1, 2003. These new guidelines stipulate that a resident can work no more than 80 hours per week and must get at least 10 hours of rest between shifts. A resident is to be on duty no more than 24 hours at a time. These standards can be exceeded by as much as 10% for educational reasons approved by the ACGME. The ACGME has stated that it will act more quickly to prosecute violators of the on-duty hours standards. The restrictions are not likely to have much effect on most radiology residency programs. Rather, programs with heavy call burdens, such as general surgery, obstetrics-gynecology, and internal medicine, are most likely to have problems with the new regulations.
The ACGME requires that sponsoring institutions have written policies and procedures for recruiting and appointing residents into each residency program. The ACGME requirements for resident eligibility and selection are given in Figure 2. Noncompliance with these regulations may lead to withdrawal of accreditation for the program.
Figure 2.
ACGME regulations for resident eligibility and selection. (Adapted from reference 1.)
The sponsoring institution is required to ensure that all residency training programs provide educational experiences in the “general competencies”: patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice (Fig 3). Because much of the content of the general competencies is unspecified by the ACGME, the institution can help develop generic programs that will satisfy the general competency requirements for multiple departments. Clearly, each department also will have to develop an educational curriculum specific to its specialty area.
Figure 3.
The six general competencies defined by the ACGME. (Adapted from reference 1.)
The sponsoring institution is also required to guide residency training programs in promoting residents' personal learning and participation in educational and scholarly activities, including teaching of other residents and students. The institution must ensure that residents participate in appropriate institutional committees whose actions affect their education or patient care. In addition, it must ensure that residents can submit confidential written evaluations of the faculty and rotations at least annually.
The institution is responsible to provide residents with adequate financial support. In addition, it must provide, in writing, the terms and conditions of employment, benefits, vacations, leave policies, and insurance to all applicants. Residents must be given a written contract specifying the terms and conditions of their appointments, and the institution must monitor the implementation of these terms by program directors, including all provisions listed in Figure 4. In addition, the institution is required to have written policies available for residents regarding the possible reduction in size or closure of a residency program and policies on moonlighting. Recently, the ACGME began requiring that program directors be aware of all moonlighting activities of the house staff in their departments. Many institutions are aiding program directors in this activity by providing forms and institutional policy for resident compliance. The ACGME institutional requirements also specify that accredited residencies cannot require residents to sign restrictive covenants (noncompetition agreements).
Figure 4.
ACGME-required provisions in institutional residency contracts.(Adapted from reference 1.)
While each residency program develops its own duty schedule, work environment, and educational experience, the institution is ultimately responsible for ensuring that each program supervises residents adequately, provides a work schedule and environment consistent with good patient care, meets the educational needs of residents, and fulfills the applicable program requirements. In particular, the institution must ensure that there is adequate supervision of residents during daytime and on-call hours and that the programs comply with the new duty hours restrictions that will go into effect on July 1, 2003. While on duty, residents must be provided with adequate food, sleeping quarters, and ancillary services, such as laboratories, radiology, medical records, and security.
Summary
The residency review committee's program requirements guide the development of the details of each ACGME-accredited residency program. The sponsoring institution, however, has the overall responsibility, through the institutional requirements, to ensure that all facets of high-quality graduate medical education are available for all residents in these programs. It is imperative that there be close interaction between residency program directors, departmental education coordinators, and the GME officials of the institution, especially as ACGME regulations have become more complex.
References
PII: S1076-6332(03)80147-2
doi:10.1016/S1076-6332(03)80147-2
© 2003 Acad Radiol. Published by Elsevier Inc. All rights reserved.
