Demystifying the ACGME: Your guide to understanding the residency accreditation body

ACGME RRC—this litany of letters means little to most otolaryngologists. However, whether you are a private practitioner or an academician, a resident in training or a program director, you should have a basic understanding of the work done by the Accreditation Council for Graduate Medical Education Residency Review Committee (ACGME RRC).

Background

The ACGME was founded in 1981 in an effort to establish an independent, non-governmental accreditation body for graduate medical education. The organizations involved in founding the ACGME include the American Board of Medical Specialties (ABMS), the American Hospital Association (AHA), the American Medical Association (AMA), the Association of American Medical Colleges (AAMC) and the Council of Medical Specialty Societies (CMSS). From the beginning, the ACGME’s purpose has been to “improve healthcare by assessing and advancing the quality of resident education through accreditation.” The ACGME wants its values of accountability, professionalism and excellence to be manifested by processes that are valid and reliable, open and transparent; actions that are respectful, collaborative, responsive and fair; and accreditation that is efficient, outcomes-based and innovative.

The ACGME currently has 28 Review Committees, including one for each of its 26 specialties, one Transitional Year Review Committee and one Institutional Review Committee. Each of these RRCs is composed of six to 15 volunteers from within that field. The otolaryngology RRC comprises 11 members: 10 voting members, including three each from the three nominating organizations, one resident member and one ex-officio (non-voting) member, who is the executive director of the American Board of Otolaryngology (ABOto). Selection of members to the RRC is by nomination from the AMA Council on Medical Education, the ABOto, and the American College of Surgeons. The group receives additional assistance from the non-voting executive director of the RRC, who is an educational professional and a permanent employee of the ACGME. A chair and vice chair of the committee are elected by the voting members and serve as the executive council of the committee, making administrative decisions in between major meetings. The full otolaryngology RRC meets twice yearly for full program reviews.

This group is charged with setting the standards for accreditation for otolaryngology training programs and ensuring that accredited programs adhere to those standards. In setting standards for the breadth of general otolaryngology training, the ACGME RRC, along with the ABOto, plays a large role in defining the scope of our specialty.

The ABOto defines the professional standards of training and knowledge in otolaryngology-head and neck surgery and certifies that individuals have met this standard. The ACGME RRC is to residency training programs what the ABOto is to individuals. The ABOto certifies individuals, while the ACGME RRC accredits otolaryngology residency training programs and, currently, two advanced training (fellowship) programs, neurotology and pediatric otolaryngology.

What We Do

How are accreditation decisions made? And what is involved in the review process? The ACGME RRC receives specific information from each program: residency case logs, resident surveys, a site visitor report and the Program Information Form (PIF) submitted by the program director. Residency case logs are entered by each resident and fellow into the ACGME data collection website. Residents also complete an annual survey designed to evaluate their program’s compliance with several ACGME requirements such as supervision, institutional support, teaching and observance of duty hour limits. Prior to an RRC review, each program director submits a PIF, which contains detailed information about the residency program curriculum, faculty and participating institution(s), along with a summary of resident duty hours, case log reviews and board exam passing rates.

In the year prior to a scheduled RRC review, a trained professional site visitor visits each program and meets with peer-selected residents, the program director and other departmental and institutional faculty and administrators. The site visitor confirms the results of the resident survey and the information presented on the PIF and clarifies other relevant information about the program.

Two RRC members who do not have a conflict of interest with the program review this data. Their report includes a review of previous citations, a description of whether these have been adequately addressed and descriptions of new citations. Based on this detailed review, each reviewer also submits a recommendation for an accreditation decision. Each reviewer presents this report at the RRC full committee meeting. Any members who work in the same state or geographic vicinity of the training program being reviewed or who have another conflict of interest with the training program being reviewed are asked to leave the room for the entire discussion and vote.

Following full committee discussion of the residency program, the committee makes an accreditation decision by open vote. Decision options include continued accreditation vs. probation, number of residents allowed per year of training, determination of cycle length and defined areas of noncompliance (citations). Accreditation cycle lengths vary from one to five years, and adverse actions such as proposed probation or decrease in resident complement are very uncommon.

Based on the citations confirmed by the committee and the accreditation decision made by committee vote, the ACGME prepares a statement of action and letter of notification and sends them to the program director in a timely fashion. The committee may also request that an interim progress report be submitted by the program in order to follow up on specific areas of concern prior to the next formal review. Duty hours violations require immediate progress reports.

Importance to Otolaryngology

So what…who cares? Truly, we all should. Residents should be comforted to know that there is a committee of resident advocates who desire to improve the training experience of otolaryngology residents across the country. The ACGME RRC is the ideal body to protect residents from programs providing inadequate training or from potential abuses such as significant imbalances between service obligations and educational activities. Additionally, the ACGME provides on its website a substantial number of free resources and materials to assist educators in their development; the website also provides notable practices and other guidelines to help faculty further improve their residency training programs. Even for those no longer associated with an academic practice, the ACGME RRC provides the service of ensuring that the new partner joining the practice has completed a residency program that meets very high standards of excellence. Becuase the ACGME RRC guarantees the excellence that we have come to expect from residency training in otolaryngology, it is crucial for the future of our specialty.

Noel Jabbour, MD, is resident member, and Brian Burkey, MD, is former chair of the Accreditation Council for Graduate Medical Education Resident Review Committee (ACGME RRC) for otolaryngology.