TAGME Study Guide 2024 PDF

NATIONAL BOARD FOR CERTIFICATION Training Administrators of Graduate Medical Education 2024 OFFICIAL TAGME ASSESSMENT STUDY GUIDE Table of Contents ACGME Common Program Requirements (Residency)............................................... 1 ACGME Common Program Requirements (Fellowship)............................................. 49 ACGME Institutional Requirements........................................................................... 94 ACGME NST Recognition for Sponsoring Institutions.............................................. 112 ACGME Glossary of Terms....................................................................................... 117 ACGME Updating ADS............................................................................................. 126 ACGME Policies and Procedures............................................................................. 133 ECFMG Certification Information Booklet............................................................... 299 NRMP Match Participation Agreement for Programs.............................................. 360 Study Guide Tips:  All assessment questions will reference information supplied in this study guide.  TAGME Study Guide numbers have been added to the top right corner in RED.  Turn on the bookmarks, for ease of navigation.  Please note the pagination from each original resource remains as published in its original format.  If a resource has a Table of Contents, it may or may not have active hyperlinks depending on how the original information was assembled.  To conduct a search within the document, hold the “Ctrl” and “F” keys simultaneously. A “Find” search box will appear. Enter a key word to search. TAGME STUDY GUIDE Page 1 of 386 ACGME Common Program Requirements (Residency) Revision Information ACGME-approved interim revision: September 17, 2022; effective July 1, 2023 Definitions For more information, see the ACGME Glossary of Terms. Core Requirements: Statements that define structure, resource, or process elements essential to every graduate medical educational program. Detail Requirements: Statements that describe a specific structure, resource, or process, for achieving compliance with a Core Requirement. Programs and sponsoring institutions in substantial compliance with the Outcome Requirements may utilize alternative or innovative approaches to meet Core Requirements. Outcome Requirements: Statements that specify expected measurable or observable attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medical education. Osteopathic Recognition For programs with or applying for Osteopathic Recognition, the Osteopathic Recognition Requirements also apply (www.acgme.org/Osteopathic Recognition). TAGME STUDY GUIDE Page 2 of 386 Common Program Requirements (Residency) Contents Introduction................................................................................................................................. 3 Int.A. Definition of Graduate Medical Education.............................................................. 3 Int.B. Definition of Specialty.............................................................................................. 3 Int.C. Length of Educational Program.............................................................................. 3 I. Oversight.............................................................................................................................. 4 I.A. Sponsoring Institution.............................................................................................. 4 I.B. Participating Sites..................................................................................................... 4 I.C. Workforce Recruitment and Retention................................................................... 5 I.D. Resources.................................................................................................................. 5 I.E. Other Learners and Health Care Personnel............................................................ 6 II. Personnel............................................................................................................................. 7 II.A. Program Director...................................................................................................... 7 II.B. Faculty..................................................................................................................... 12 II.C. Program Coordinator.............................................................................................. 15 II.D. Other Program Personnel...................................................................................... 16 III. Resident Appointments.................................................................................................... 17 III.A. Eligibility Requirements......................................................................................... 17 III.B. Resident Complement............................................................................................ 18 III.C. Resident Transfers................................................................................................. 18 IV. Educational Program......................................................................................................... 19 IV.A. Educational Components....................................................................................... 19 IV.B. ACGME Competencies........................................................................................... 20 IV.C. Curriculum Organization and Resident Experiences.......................................... 24 IV.D. Scholarship............................................................................................................. 24 V. Evaluation........................................................................................................................... 26 V.A. Resident Evaluation................................................................................................ 26 V.B. Faculty Evaluation.................................................................................................. 30 V.C. Program Evaluation and Improvement................................................................. 31 VI. The Learning and Working Environment........................................................................ 34 VI.A. Patient Safety, Quality Improvement, Supervision, and Accountability............ 34 VI.B. Professionalism...................................................................................................... 38 VI.C. Well-Being............................................................................................................... 40 VI.D. Fatigue Mitigation................................................................................................... 42 VI.E. Clinical Responsibilities, Teamwork, and Transitions of Care........................... 43 VI.F. Clinical Experience and Education....................................................................... 43 Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 2 of 48 TAGME STUDY GUIDE Page 3 of 386 Where applicable, text in italics describes the underlying philosophy of the requirements in that section. These philosophic statements are not program requirements and are therefore not citable. Note: Review Committees may further specify only where indicated by “The Review Committee may/must further specify.” Introduction Int.A. Definition of Graduate Medical Education Graduate medical education is the crucial step of professional development between medical school and autonomous clinical practice. It is in this vital phase of the continuum of medical education that residents learn to provide optimal patient care under the supervision of faculty members who not only instruct, but serve as role models of excellence, compassion, cultural sensitivity, professionalism, and scholarship. Graduate medical education transforms medical students into physician scholars who care for the patient, patient’s family, and a diverse community; create and integrate new knowledge into practice; and educate future generations of physicians to serve the public. Practice patterns established during graduate medical education persist many years later. Graduate medical education has as a core tenet the graded authority and responsibility for patient care. The care of patients is undertaken with appropriate faculty supervision and conditional independence, allowing residents to attain the knowledge, skills, attitudes, judgment, and empathy required for autonomous practice. Graduate medical education develops physicians who focus on excellence in delivery of safe, equitable, affordable, quality care; and the health of the populations they serve. Graduate medical education values the strength that a diverse group of physicians brings to medical care, and the importance of inclusive and psychologically safe learning environments. Graduate medical education occurs in clinical settings that establish the foundation for practice-based and lifelong learning. The professional development of the physician, begun in medical school, continues through faculty modeling of the effacement of self-interest in a humanistic environment that emphasizes joy in curiosity, problem-solving, academic rigor, and discovery. This transformation is often physically, emotionally, and intellectually demanding and occurs in a variety of clinical learning environments committed to graduate medical education and the well-being of patients, residents, fellows, faculty members, students, and all members of the health care team. Int.B. Definition of Specialty [The Review Committee must further specify] Int.C. Length of Educational Program Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 3 of 48 TAGME STUDY GUIDE Page 4 of 386 [The Review Committee must further specify] I. Oversight I.A. Sponsoring Institution The Sponsoring Institution is the organization or entity that assumes the ultimate financial and academic responsibility for a program of graduate medical education, consistent with the ACGME Institutional Requirements. When the Sponsoring Institution is not a rotation site for the program, the most commonly utilized site of clinical activity for the program is the primary clinical site. Background and Intent: Participating sites will reflect the health care needs of the community and the educational needs of the residents. A wide variety of organizations may provide a robust educational experience and, thus, Sponsoring Institutions and participating sites may encompass inpatient and outpatient settings including, but not limited to a university, a medical school, a teaching hospital, a nursing home, a school of public health, a health department, a public health agency, an organized health care delivery system, a medical examiner’s office, an educational consortium, a teaching health center, a physician group practice, federally qualified health center, or an educational foundation. I.A.1. The program must be sponsored by one ACGME-accredited Sponsoring Institution. (Core) I.B. Participating Sites A participating site is an organization providing educational experiences or educational assignments/rotations for residents. I.B.1. The program, with approval of its Sponsoring Institution, must designate a primary clinical site. (Core) [The Review Committee may specify which other specialties/programs must be present at the primary clinical site] I.B.2. There must be a program letter of agreement (PLA) between the program and each participating site that governs the relationship between the program and the participating site providing a required assignment. (Core) I.B.2.a) The PLA must: I.B.2.a).(1) be renewed at least every 10 years; and, (Core) I.B.2.a).(2) be approved by the designated institutional official (DIO). (Core) I.B.3. The program must monitor the clinical learning and working environment at all participating sites. (Core) Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 4 of 48 TAGME STUDY GUIDE Page 5 of 386 I.B.3.a) At each participating site there must be one faculty member, designated by the program director as the site director, who is accountable for resident education at that site, in collaboration with the program director. (Core) Background and Intent: While all residency programs must be sponsored by a single ACGME-accredited Sponsoring Institution, many programs will utilize other clinical settings to provide required or elective training experiences. At times it is appropriate to utilize community sites that are not owned by or affiliated with the Sponsoring Institution. Some of these sites may be remote for geographic, transportation, or communication issues. When utilizing such sites, the program must ensure the quality of the educational experience. Suggested elements to be considered in PLAs will be found in the Guide to the Common Program Requirements. These include: Identifying the faculty members who will assume educational and supervisory responsibility for residents Specifying the responsibilities for teaching, supervision, and formal evaluation of residents Specifying the duration and content of the educational experience Stating the policies and procedures that will govern resident education during the assignment I.B.4. The program director must submit any additions or deletions of participating sites routinely providing an educational experience, required for all residents, of one month full time equivalent (FTE) or more through the ACGME’s Accreditation Data System (ADS). (Core) [The Review Committee may further specify] I.C. Workforce Recruitment and Retention The program, in partnership with its Sponsoring Institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative GME staff members, and other relevant members of its academic community. (Core) Background and Intent: It is expected that the Sponsoring Institution has, and programs implement, policies and procedures related to recruitment and retention of individuals underrepresented in medicine and medical leadership in accordance with the Sponsoring Institution’s mission and aims. I.D. Resources I.D.1. The program, in partnership with its Sponsoring Institution, must ensure the availability of adequate resources for resident education. (Core) [The Review Committee must further specify] Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 5 of 48 TAGME STUDY GUIDE Page 6 of 386 I.D.2. The program, in partnership with its Sponsoring Institution, must ensure healthy and safe learning and working environments that promote resident well-being and provide for: I.D.2.a) access to food while on duty; (Core) I.D.2.b) safe, quiet, clean, and private sleep/rest facilities available and accessible for residents with proximity appropriate for safe patient care; (Core) Background and Intent: Care of patients within a hospital or health system occurs continually through the day and night. Such care requires that residents function at their peak abilities, which requires the work environment to provide them with the ability to meet their basic needs within proximity of their clinical responsibilities. Access to food and rest are examples of these basic needs, which must be met while residents are working. Residents should have access to refrigeration where food may be stored. Food should be available when residents are required to be in the hospital overnight. Rest facilities are necessary, even when overnight call is not required, to accommodate the fatigued resident. I.D.2.c) clean and private facilities for lactation that have refrigeration capabilities, with proximity appropriate for safe patient care; (Core) Background and Intent: Sites must provide private and clean locations where residents may lactate and store the milk within a refrigerator. These locations should be in close proximity to clinical responsibilities. It would be helpful to have additional support within these locations that may assist the resident with the continued care of patients, such as a computer and a phone. While space is important, the time required for lactation is also critical for the well-being of the resident and the resident's family, as outlined in VI.C.1.c).(1) I.D.2.d) security and safety measures appropriate to the participating site; and, (Core) I.D.2.e) accommodations for residents with disabilities consistent with the Sponsoring Institution’s policy. (Core) I.D.3. Residents must have ready access to specialty-specific and other appropriate reference material in print or electronic format. This must include access to electronic medical literature databases with full text capabilities. (Core) I.E. Other Learners and Health Care Personnel The presence of other learners and other health care personnel, including, but not limited to residents from other programs, subspecialty fellows, and advanced practice providers, must not negatively impact the appointed residents’ education. (Core) Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 6 of 48 TAGME STUDY GUIDE Page 7 of 386 [The Review Committee may further specify] Background and Intent: The clinical learning environment has become increasingly complex and often includes care providers, students, and post-graduate residents and fellows from multiple disciplines. The presence of these practitioners and their learners enriches the learning environment. Programs have a responsibility to monitor the learning environment to ensure that residents’ education is not compromised by the presence of other providers and learners. II. Personnel II.A. Program Director II.A.1. There must be one faculty member appointed as program director with authority and accountability for the overall program, including compliance with all applicable program requirements. (Core) II.A.1.a) The Sponsoring Institution’s GMEC must approve a change in program director and must verify the program director’s licensure and clinical appointment. (Core) II.A.1.a).(1) Final approval of the program director resides with the Review Committee. (Core) [Previously II.A.1.b)] [For specialties that require Review Committee approval of the program director, the Review Committee may further specify. This requirement will be deleted for those specialties that do not require Review Committee approval of the program director.] Background and Intent: While the ACGME recognizes the value of input from numerous individuals in the management of a residency, a single individual must be designated as program director and have overall responsibility for the program. The program director’s nomination is reviewed and approved by the GMEC. II.A.1.b) The program must demonstrate retention of the program director for a length of time adequate to maintain continuity of leadership and program stability. (Core) [The Review Committee may further specify] Background and Intent: The success of residency programs is generally enhanced by continuity in the program director position. The professional activities required of a program director are unique and complex and take time to master. All programs are encouraged to undertake succession planning to facilitate program stability when there is necessary turnover in the program director position. II.A.2. The program director and, as applicable, the program’s leadership team, must be provided with support adequate for administration of the program based upon its size and configuration. (Core) [The Review Committee must further specify minimum dedicated time for program administration, and will determine whether Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 7 of 48 TAGME STUDY GUIDE Page 8 of 386 program leadership refers to the program director or both the program director and associate/assistant program director(s).] Background and Intent: To achieve successful graduate medical education, individuals serving as education and administrative leaders of residency programs, as well as those significantly engaged in the education, supervision, evaluation, and mentoring of residents, must have sufficient dedicated professional time to perform the vital activities required to sustain an accredited program. The ultimate outcome of graduate medical education is excellence in resident education and patient care. The program director and, as applicable, the program leadership team, devote a portion of their professional effort to the oversight and management of the residency program, as defined in II.A.4.-II.A.4.a).(16). Both provision of support for the time required for the leadership effort and flexibility regarding how this support is provided are important. Programs, in partnership with their Sponsoring Institutions, may provide support for this time in a variety of ways. Examples of support may include, but are not limited to, salary support, supplemental compensation, educational value units, or relief of time from other professional duties. Program directors and, as applicable, members of the program leadership team, who are new to the role may need to devote additional time to program oversight and management initially as they learn and become proficient in administering the program. It is suggested that during this initial period the support described above be increased as needed. In addition, it is important to remember that the dedicated time and support requirement for ACGME activities is a minimum, recognizing that, depending on the unique needs of the program, additional support may be warranted. The need to ensure adequate resources, including adequate support and dedicated time for the program director, is also addressed in Institutional Requirement II.B.1. The amount of support and dedicated time needed for individual programs will vary based on a number of factors and may exceed the minimum specified in the applicable specialty/subspecialty-specific Program Requirements. It is expected that the Sponsoring Institution, in partnership with its accredited programs, will ensure support for program directors to fulfill their program responsibilities effectively. II.A.3. Qualifications of the program director: II.A.3.a) must include specialty expertise and at least three years of documented educational and/or administrative experience, or qualifications acceptable to the Review Committee; (Core) Background and Intent: Leading a program requires knowledge and skills that are established during residency and subsequently further developed. The time period from completion of residency until assuming the role of program director allows the individual to cultivate leadership abilities while becoming professionally established. The three-year period is intended for the individual's professional maturation. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 8 of 48 TAGME STUDY GUIDE Page 9 of 386 The broad allowance for educational and/or administrative experience recognizes that strong leaders arise through diverse pathways. These areas of expertise are important when identifying and appointing a program director. The choice of a program director should be informed by the mission of the program and the needs of the community. In certain circumstances, the program and Sponsoring Institution may propose and the Review Committee may accept a candidate for program director who fulfills these goals but does not meet the three-year minimum. II.A.3.b) must include current certification in the specialty for which they are the program director by the American Board of _____ or by the American Osteopathic Board of _____, or specialty qualifications that are acceptable to the Review Committee; and, (Core) [The Review Committee may further specify acceptable specialty qualifications or that only ABMS and AOA certification will be considered acceptable] II.A.3.c) must include ongoing clinical activity. (Core) Background and Intent: A program director is a role model for faculty members and residents. The program director must participate in clinical activity consistent with the specialty. This activity will allow the program director to role model the Core Competencies for the faculty members and residents. [The Review Committee may further specify additional program director qualifications] II.A.4. Program Director Responsibilities The program director must have responsibility, authority, and accountability for: administration and operations; teaching and scholarly activity; resident recruitment and selection, evaluation, and promotion of residents, and disciplinary action; supervision of residents; and resident education in the context of patient care. (Core) II.A.4.a) The program director must: II.A.4.a).(1) be a role model of professionalism; (Core) Background and Intent: The program director, as the leader of the program, must serve as a role model to residents in addition to fulfilling the technical aspects of the role. As residents are expected to demonstrate compassion, integrity, and respect for others, they must be able to look to the program director as an exemplar. It is of utmost importance, therefore, that the program director model outstanding professionalism, high quality patient care, educational excellence, and a scholarly approach to work. The program director creates an environment where respectful discussion is welcome, with the goal of continued improvement of the educational experience. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 9 of 48 TAGME STUDY GUIDE Page 10 of 386 II.A.4.a).(2) design and conduct the program in a fashion consistent with the needs of the community, the mission(s) of the Sponsoring Institution, and the mission(s) of the program; (Core) Background and Intent: The mission of institutions participating in graduate medical education is to improve the health of the public. Each community has health needs that vary based upon location and demographics. Programs must understand the structural and social determinants of health of the populations they serve and incorporate them in the design and implementation of the program curriculum, with the ultimate goal of addressing these needs and eliminating health disparities. II.A.4.a).(3) administer and maintain a learning environment conducive to educating the residents in each of the ACGME Competency domains; (Core) Background and Intent: The program director may establish a leadership team to assist in the accomplishment of program goals. Residency programs can be highly complex. In a complex organization, the leader typically has the ability to delegate authority to others, yet remains accountable. The leadership team may include physician and non-physician personnel with varying levels of education, training, and experience. II.A.4.a).(4) have the authority to approve or remove physicians and non-physicians as faculty members at all participating sites, including the designation of core faculty members, and must develop and oversee a process to evaluate candidates prior to approval; (Core) Background and Intent: The provision of optimal and safe patient care requires a team approach. The education of residents by non-physician educators may enable the resident to better manage patient care and provides valuable advancement of the residents’ knowledge. Furthermore, other individuals contribute to the education of residents in the basic science of the specialty or in research methodology. If the program director determines that the contribution of a non-physician individual is significant to the education of the residents, the program director may designate the individual as a program faculty member or a program core faculty member. II.A.4.a).(5) have the authority to remove residents from supervising interactions and/or learning environments that do not meet the standards of the program; (Core) Background and Intent: The program director has the responsibility to ensure that all who educate residents effectively role model the Core Competencies. Working with a resident is a privilege that is earned through effective teaching and professional role modeling. This privilege may be removed by the program director when the standards of the clinical learning environment are not met. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 10 of 48 TAGME STUDY GUIDE Page 11 of 386 There may be faculty in a department who are not part of the educational program, and the program director controls who is teaching the residents. II.A.4.a).(6) submit accurate and complete information required and requested by the DIO, GMEC, and ACGME; (Core) Background and Intent: This includes providing information in the form and format requested by the ACGME and obtaining requisite sign-off by the DIO. II.A.4.a).(7) provide a learning and working environment in which residents have the opportunity to raise concerns, report mistreatment, and provide feedback in a confidential manner as appropriate, without fear of intimidation or retaliation; (Core) II.A.4.a).(8) ensure the program’s compliance with the Sponsoring Institution’s policies and procedures related to grievances and due process, including when action is taken to suspend or dismiss, or not to promote or renew the appointment of a resident; (Core) Background and Intent: A program does not operate independently of its Sponsoring Institution. It is expected that the program director will be aware of the Sponsoring Institution’s policies and procedures, and will ensure they are followed by the program’s leadership, faculty members, support personnel, and residents. II.A.4.a).(9) ensure the program’s compliance with the Sponsoring Institution’s policies and procedures on employment and non-discrimination; (Core) II.A.4.a).(9).(a) Residents must not be required to sign a non- competition guarantee or restrictive covenant. (Core) II.A.4.a).(10) document verification of education for all residents within 30 days of completion of or departure from the program; and, (Core) II.A.4.a).(11) provide verification of an individual resident’s education upon the resident’s request, within 30 days; and (Core) Background and Intent: Primary verification of graduate medical education is important to credentialing of physicians for further training and practice. Such verification must be accurate and timely. Sponsoring Institution and program policies for record retention are important to facilitate timely documentation of residents who have previously completed the program. Residents who leave the program prior to completion also require timely documentation of their summative evaluation. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 11 of 48 TAGME STUDY GUIDE Page 12 of 386 II.A.4.a).(12) provide applicants who are offered an interview with information related to the applicant’s eligibility for the relevant specialty board examination(s). (Core) [This requirement may be omitted at the discretion of the Review Committee] II.B. Faculty Faculty members are a foundational element of graduate medical education – faculty members teach residents how to care for patients. Faculty members provide an important bridge allowing residents to grow and become practice-ready, ensuring that patients receive the highest quality of care. They are role models for future generations of physicians by demonstrating compassion, commitment to excellence in teaching and patient care, professionalism, and a dedication to lifelong learning. Faculty members experience the pride and joy of fostering the growth and development of future colleagues. The care they provide is enhanced by the opportunity to teach and model exemplary behavior. By employing a scholarly approach to patient care, faculty members, through the graduate medical education system, improve the health of the individual and the population. Faculty members ensure that patients receive the level of care expected from a specialist in the field. They recognize and respond to the needs of the patients, residents, community, and institution. Faculty members provide appropriate levels of supervision to promote patient safety. Faculty members create an effective learning environment by acting in a professional manner and attending to the well-being of the residents and themselves. Background and Intent: “Faculty” refers to the entire teaching force responsible for educating residents. The term “faculty,” including “core faculty,” does not imply or require an academic appointment. II.B.1. There must be a sufficient number of faculty members with competence to instruct and supervise all residents. (Core) [The Review Committee may further specify] II.B.2. Faculty members must: II.B.2.a) be role models of professionalism; (Core) II.B.2.b) demonstrate commitment to the delivery of safe, equitable, high-quality, cost-effective, patient-centered care; (Core) Background and Intent: Patients have the right to expect quality, cost-effective care with patient safety at its core. The foundation for meeting this expectation is formed during residency and fellowship. Faculty members model these goals and continually strive for improvement in care and cost, embracing a commitment to the patient and the community they serve. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 12 of 48 TAGME STUDY GUIDE Page 13 of 386 II.B.2.c) demonstrate a strong interest in the education of residents, including devoting sufficient time to the educational program to fulfill their supervisory and teaching responsibilities; (Core) II.B.2.d) administer and maintain an educational environment conducive to educating residents; (Core) II.B.2.e) regularly participate in organized clinical discussions, rounds, journal clubs, and conferences; and, (Core) II.B.2.f) pursue faculty development designed to enhance their skills at least annually: (Core) Background and Intent: Faculty development is intended to describe structured programming developed for the purpose of enhancing transference of knowledge, skill, and behavior from the educator to the learner. Faculty development may occur in a variety of configurations (lecture, workshop, etc.) using internal and/or external resources. Programming is typically needs-based (individual or group) and may be specific to the institution or the program. Faculty development programming is to be reported for the residency program faculty in the aggregate. II.B.2.f).(1) as educators and evaluators; (Detail) II.B.2.f).(2) in quality improvement, eliminating health inequities, and patient safety; (Detail) II.B.2.f).(3) in fostering their own and their residents’ well-being; and, (Detail) II.B.2.f).(4) in patient care based on their practice-based learning and improvement efforts. (Detail) Background and Intent: Practice-based learning serves as the foundation for the practice of medicine. Through a systematic analysis of one’s practice and review of the literature, one is able to make adjustments that improve patient outcomes and care. Thoughtful consideration to practice-based analysis improves quality of care, as well as patient safety. This allows faculty members to serve as role models for residents in practice-based learning. [The Review Committee may further specify additional faculty responsibilities] II.B.3. Faculty Qualifications II.B.3.a) Faculty members must have appropriate qualifications in their field and hold appropriate institutional appointments. (Core) [The Review Committee may further specify] II.B.3.b) Physician faculty members must: Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 13 of 48 TAGME STUDY GUIDE Page 14 of 386 II.B.3.b).(1) have current certification in the specialty by the American Board of _____ or the American Osteopathic Board of _____, or possess qualifications judged acceptable to the Review Committee. (Core) [The Review Committee may further specify additional qualifications and/or requirements regarding non-physician faculty members] II.B.4. Core Faculty Core faculty members must have a significant role in the education and supervision of residents and must devote a significant portion of their entire effort to resident education and/or administration, and must, as a component of their activities, teach, evaluate, and provide formative feedback to residents. (Core) Background and Intent: Core faculty members are critical to the success of resident education. They support the program leadership in developing, implementing, and assessing curriculum, mentoring residents, and assessing residents’ progress toward achievement of competence in and the autonomous practice of the specialty. Core faculty members should be selected for their broad knowledge of and involvement in the program, permitting them to effectively evaluate the program. Core faculty members may also be selected for their specific expertise and unique contribution to the program. Core faculty members are engaged in a broad range of activities, which may vary across programs and specialties. Core faculty members provide clinical teaching and supervision of residents, and also participate in non-clinical activities related to resident education and program administration. Examples of these non- clinical activities include, but are not limited to, interviewing and selecting resident applicants, providing didactic instruction, mentoring residents, simulation exercises, completing the annual ACGME Faculty Survey, and participating on the program’s Clinical Competency Committee, Program Evaluation Committee, and other GME committees. II.B.4.a) Core faculty members must complete the annual ACGME Faculty Survey. (Core) [The Review Committee must specify the minimum number of core faculty and/or the core faculty-resident ratio] [The Review Committee may further specify either: (1) requirements regarding dedicated time and support for core faculty members’ non-clinical responsibilities related to resident education and/or administration of the program, or (2) requirements regarding the role and responsibilities of core faculty members, inclusive of both clinical and non-clinical activities, and the corresponding time commitment required to meet those responsibilities.] Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 14 of 48 TAGME STUDY GUIDE Page 15 of 386 If the Review Committee adds requirements as described in number (1) above, the Review Committee may choose to include background and intent as follows: Background and Intent: Provision of support for the time required for the core faculty members’ responsibilities related to resident education and/or administration of the program, as well as flexibility regarding how this support is provided, are important. Programs, in partnership with their Sponsoring Institutions, may provide support for this time in a variety of ways. Examples of support may include, but are not limited to, salary support, supplemental compensation, educational value units, or relief of time from other professional duties. It is important to remember that the dedicated time and support requirement is a minimum, recognizing that, depending on the unique needs of the program, additional support may be warranted. The need to ensure adequate resources, including adequate support and dedicated time for the core faculty members, is also addressed in Institutional Requirement II.B.2. The amount of support and dedicated time needed for individual programs will vary based on a number of factors and may exceed the minimum specified in the applicable specialty-/ subspecialty-specific Program Requirements. If the Review Committee adds requirements as described in number (2) above, the following Background and Intent must be included: Background and Intent: The core faculty time requirements address the role and responsibilities of core faculty members, inclusive of both clinical and non- clinical activities, and the corresponding time to meet those responsibilities. The requirements do not address how this is accomplished, and do not mandate dedicated or protected time for these activities. Programs, in partnership with their Sponsoring Institutions, will determine how compliance with the requirements is achieved. [The Review Committee may specify requirements specific to associate program director(s)] II.C. Program Coordinator II.C.1. There must be a program coordinator. (Core) II.C.2. The program coordinator must be provided with dedicated time and support adequate for administration of the program based upon its size and configuration. (Core) [The Review Committee must further specify minimum dedicated time for the program coordinator] Background and Intent: The requirement does not address the source of funding required to provide the specified salary support. Each program requires a lead administrative person, frequently referred to as a program coordinator, administrator, or as otherwise titled by the institution. This person will frequently manage the day-to-day operations of the program and serve as Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 15 of 48 TAGME STUDY GUIDE Page 16 of 386 an important liaison and facilitator between the learners, faculty and other staff members, and the ACGME. Individuals serving in this role are recognized as program coordinators by the ACGME. The program coordinator is a key member of the leadership team and is critical to the success of the program. As such, the program coordinator must possess skills in leadership and personnel management appropriate to the complexity of the program. Program coordinators are expected to develop in-depth knowledge of the ACGME and Program Requirements, including policies and procedures. Program coordinators assist the program director in meeting accreditation requirements, educational programming, and support of residents. Programs, in partnership with their Sponsoring Institutions, should encourage the professional development of their program coordinators and avail them of opportunities for both professional and personal growth. Programs with fewer residents may not require a full-time coordinator; one coordinator may support more than one program. The minimum required dedicated time and support specified in II.C.2.a) is inclusive of activities directly related to administration of the accredited program. It is understood that coordinators often have additional responsibilities, beyond those directly related to program administration, including, but not limited to, departmental administrative responsibilities, medical school clerkships, planning lectures that are not solely intended for the accredited program, and mandatory reporting for entities other than the ACGME. Assignment of these other responsibilities will necessitate consideration of allocation of additional support so as not to preclude the coordinator from devoting the time specified above solely to administrative activities that support the accredited program. In addition, it is important to remember that the dedicated time and support requirement for ACGME activities is a minimum, recognizing that, depending on the unique needs of the program, additional support may be warranted. The need to ensure adequate resources, including adequate support and dedicated time for the program coordinator, is also addressed in Institutional Requirement II.B.4. The amount of support and dedicated time needed for individual programs will vary based on a number of factors and may exceed the minimum specified in the applicable specialty/subspecialty-specific Program Requirements. It is expected that the Sponsoring Institution, in partnership with its accredited programs, will ensure support for program coordinators to fulfill their program responsibilities effectively. II.D. Other Program Personnel The program, in partnership with its Sponsoring Institution, must jointly ensure the availability of necessary personnel for the effective administration of the program. (Core) [The Review Committee may further specify] Background and Intent: Multiple personnel may be required to effectively administer a program. These may include staff members with clerical skills, project managers, education experts, and staff members to maintain electronic communication for the Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 16 of 48 TAGME STUDY GUIDE Page 17 of 386 program. These personnel may support more than one program in more than one discipline. III. Resident Appointments III.A. Eligibility Requirements III.A.1. An applicant must meet one of the following qualifications to be eligible for appointment to an ACGME-accredited program: (Core) III.A.1.a) graduation from a medical school in the United States or Canada, accredited by the Liaison Committee on Medical Education (LCME) or graduation from a college of osteopathic medicine in the United States, accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation (AOACOCA); or, (Core) III.A.1.b) graduation from a medical school outside of the United States or Canada, and meeting one of the following additional qualifications: (Core) III.A.1.b).(1) holding a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) prior to appointment; or, (Core) III.A.1.b).(2) holding a full and unrestricted license to practice medicine in the United States licensing jurisdiction in which the ACGME-accredited program is located. (Core) III.A.2. All prerequisite post-graduate clinical education required for initial entry or transfer into ACGME-accredited residency programs must be completed in ACGME-accredited residency programs, AOA- approved residency programs, Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada, or in residency programs with ACGME International (ACGME-I) Advanced Specialty Accreditation. (Core) III.A.2.a) Residency programs must receive verification of each resident’s level of competency in the required clinical field using ACGME, CanMEDS, or ACGME-I Milestones evaluations from the prior training program upon matriculation. (Core) [The Review Committee may further specify prerequisite postgraduate clinical education] Background and Intent: Programs with ACGME-I Foundational Accreditation or from institutions with ACGME-I accreditation do not qualify unless the program has also achieved ACGME-I Advanced Specialty Accreditation. To ensure entrants into ACGME- accredited programs from ACGME-I programs have attained the prerequisite milestones for this training, they must be from programs that have ACGME-I Advanced Specialty Accreditation. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 17 of 48 TAGME STUDY GUIDE Page 18 of 386 III.A.3. Resident Eligibility Exception The Review Committee for ______ will allow the following exception to the resident eligibility requirements: (Core) [Note: A Review Committee may permit the eligibility exception if the specialty requires completion of a prerequisite residency program prior to admission. If the specialty-specific Program Requirements define multiple program formats, the Review Committee may permit the exception only for the format(s) that require completion of a prerequisite residency program prior to admission. If this language is not applicable, this section will not appear in the specialty- specific requirements.] III.A.3.a) An ACGME-accredited residency program may accept an exceptionally qualified international graduate applicant who does not satisfy the eligibility requirements listed in III.A.1.- III.A.2., but who does meet all of the following additional qualifications and conditions: (Core) III.A.3.a).(1) evaluation by the program director and residency selection committee of the applicant’s suitability to enter the program, based on prior training and review of the summative evaluations of this training; and, (Core) III.A.3.a).(2) review and approval of the applicant’s exceptional qualifications by the GMEC; and, (Core) III.A.3.a).(3) verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification. (Core) III.A.3.b) Applicants accepted through this exception must have an evaluation of their performance by the Clinical Competency Committee within 12 weeks of matriculation. (Core) III.B. Resident Complement The program director must not appoint more residents than approved by the Review Committee. (Core) [The Review Committee may further specify minimum complement numbers] Background and Intent: Programs are required to request approval of all complement changes, whether temporary or permanent, by the Review Committee through ADS. Permanent increases require prior approval from the Review Committee and temporary increases may also require approval. Specialty-specific instructions for requesting a complement increase are found in the “Documents and Resources” page of the applicable specialty section of the ACGME website. III.C. Resident Transfers Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 18 of 48 TAGME STUDY GUIDE Page 19 of 386 The program must obtain verification of previous educational experiences and a summative competency-based performance evaluation prior to acceptance of a transferring resident, and Milestones evaluations upon matriculation. (Core) [The Review Committee may further specify] IV. Educational Program The ACGME accreditation system is designed to encourage excellence and innovation in graduate medical education regardless of the organizational affiliation, size, or location of the program. The educational program must support the development of knowledgeable, skillful physicians who provide compassionate care. It is recognized programs may place different emphasis on research, leadership, public health, etc. It is expected that the program aims will reflect the nuanced program-specific goals for it and its graduates; for example, it is expected that a program aiming to prepare physician-scientists will have a different curriculum from one focusing on community health. IV.A. Educational Components The curriculum must contain the following educational components: IV.A.1. a set of program aims consistent with the Sponsoring Institution’s mission, the needs of the community it serves, and the desired distinctive capabilities of its graduates, which must be made available to program applicants, residents, and faculty members; (Core) IV.A.2. competency-based goals and objectives for each educational experience designed to promote progress on a trajectory to autonomous practice. These must be distributed, reviewed, and available to residents and faculty members; (Core) Background and Intent: The trajectory to autonomous practice is documented by Milestones evaluations. Milestones are considered formative and should be used to identify learning needs. Milestones data may lead to focused or general curricular revision in any given program or to individualized learning plans for any specific resident. IV.A.3. delineation of resident responsibilities for patient care, progressive responsibility for patient management, and graded supervision; (Core) Background and Intent: These responsibilities may generally be described by PGY level and specifically by Milestones progress as determined by the Clinical Competency Committee. This approach encourages the transition to competency- based education. An advanced learner may be granted more responsibility independent of PGY level and a learner needing more time to accomplish a certain task may do so in a focused rather than global manner. Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 19 of 48 TAGME STUDY GUIDE Page 20 of 386 IV.A.4. a broad range of structured didactic activities; and, (Core) IV.A.4.a) Residents must be provided with protected time to participate in core didactic activities. (Core) Background and Intent: It is intended that residents will participate in structured didactic activities. It is recognized that there may be circumstances in which this is not possible. Programs should define core didactic activities for which time is protected and the circumstances in which residents may be excused from these didactic activities. Didactic activities may include, but are not limited to, lectures, conferences, courses, labs, asynchronous learning, simulations, drills, case discussions, grand rounds, didactic teaching, and education in critical appraisal of medical evidence. IV.A.5. formal educational activities that promote patient safety-related goals, tools, and techniques. (Core) IV.B. ACGME Competencies Background and Intent: The Competencies provide a conceptual framework describing the required domains for a trusted physician to enter autonomous practice. These Competencies are core to the practice of all physicians, although the specifics are further defined by each specialty. The developmental trajectories in each of the Competencies are articulated through the Milestones for each specialty. IV.B.1. The program must integrate the following ACGME Competencies into the curriculum: IV.B.1.a) Professionalism Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. (Core) IV.B.1.a).(1) Residents must demonstrate competence in: IV.B.1.a).(1).(a) compassion, integrity, and respect for others; (Core) IV.B.1.a).(1).(b) responsiveness to patient needs that supersedes self-interest; (Core) IV.B.1.a).(1).(c) cultural humility; (Core) IV.B.1.a).(1).(d) respect for patient privacy and autonomy; (Core) IV.B.1.a).(1).(e) accountability to patients, society, and the profession; (Core) IV.B.1.a).(1).(f) respect and responsiveness to diverse patient populations, including but not limited to Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 20 of 48 TAGME STUDY GUIDE Page 21 of 386 diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation; (Core) IV.B.1.a).(1).(g) ability to recognize and develop a plan for one’s own personal and professional well-being; and, (Core) IV.B.1.a).(1).(h) appropriately disclosing and addressing conflict or duality of interest. (Core) Background and Intent: This includes the recognition that under certain circumstances, the interests of the patient may be best served by transitioning care to another practitioner. Examples include fatigue, conflict or duality of interest, not connecting well with a patient, or when another physician would be better for the situation based on skill set or knowledge base. IV.B.1.b) Patient Care and Procedural Skills Background and Intent: Quality patient care is safe, effective, timely, efficient, patient- centered, equitable, and designed to improve population health, while reducing per capita costs. In addition, there should be a focus on improving the clinician’s well- being as a means to improve patient care and reduce burnout among residents, fellows, and practicing physicians. IV.B.1.b).(1) Residents must be able to provide patient care that is patient- and family-centered, compassionate, equitable, appropriate, and effective for the treatment of health problems and the promotion of health. (Core) [The Review Committee must further specify] IV.B.1.b).(2) Residents must be able to perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. (Core) [The Review Committee may further specify] IV.B.1.c) Medical Knowledge Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social- behavioral sciences, including scientific inquiry, as well as the application of this knowledge to patient care. (Core) [The Review Committee must further specify] IV.B.1.d) Practice-based Learning and Improvement Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. (Core) Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 21 of 48 TAGME STUDY GUIDE Page 22 of 386 IV.B.1.d).(1) Residents must demonstrate competence in: IV.B.1.d).(1).(a) identifying strengths, deficiencies, and limits in one’s knowledge and expertise; (Core) IV.B.1.d).(1).(b) setting learning and improvement goals; (Core) IV.B.1.d).(1).(c) identifying and performing appropriate learning activities; (Core) IV.B.1.d).(1).(d) systematically analyzing practice using quality improvement methods, including activities aimed at reducing health care disparities, and implementing changes with the goal of practice improvement; (Core) IV.B.1.d).(1).(e) incorporating feedback and formative evaluation into daily practice; and, (Core) IV.B.1.d).(1).(f) locating, appraising, and assimilating evidence from scientific studies related to their patients’ health problems. (Core) [The Review Committee may further specify by adding to the list of sub-competencies] IV.B.1.e) Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (Core) IV.B.1.e).(1) Residents must demonstrate competence in: IV.B.1.e).(1).(a) communicating effectively with patients and patients’ families, as appropriate, across a broad range of socioeconomic circumstances, cultural backgrounds, and language capabilities, learning to engage interpretive services as required to provide appropriate care to each patient; (Core) IV.B.1.e).(1).(b) communicating effectively with physicians, other health professionals, and health-related agencies; (Core) IV.B.1.e).(1).(c) working effectively as a member or leader of a health care team or other professional group; (Core) Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 22 of 48 TAGME STUDY GUIDE Page 23 of 386 IV.B.1.e).(1).(d) educating patients, patients’ families, students, other residents, and other health professionals; (Core) IV.B.1.e).(1).(e) acting in a consultative role to other physicians and health professionals; (Core) IV.B.1.e).(1).(f) maintaining comprehensive, timely, and legible health care records, if applicable. (Core) IV.B.1.e).(2) Residents must learn to communicate with patients and patients’ families to partner with them to assess their care goals, including, when appropriate, end-of- life goals. (Core) [The Review Committee may further specify by adding to the list of sub-competencies] IV.B.1.f) Systems-based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, including the structural and social determinants of health, as well as the ability to call effectively on other resources to provide optimal health care. (Core) Background and Intent: Medical practice occurs in the context of an increasingly complex clinical care environment where optimal patient care requires attention to compliance with external and internal administrative and regulatory requirements. IV.B.1.f).(1) Residents must demonstrate competence in: IV.B.1.f).(1).(a) working effectively in various health care delivery settings and systems relevant to their clinical specialty; (Core) IV.B.1.f).(1).(b) coordinating patient care across the health care continuum and beyond as relevant to their clinical specialty; (Core) Background and Intent: Every patient deserves to be treated as a whole person. Therefore it is recognized that any one component of the health care system does not meet the totality of the patient's needs. An appropriate transition plan requires coordination and forethought by an interdisciplinary team. The patient benefits from proper care and the system benefits from proper use of resources. IV.B.1.f).(1).(c) advocating for quality patient care and optimal patient care systems; (Core) Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 23 of 48 TAGME STUDY GUIDE Page 24 of 386 IV.B.1.f).(1).(d) participating in identifying system errors and implementing potential systems solutions; (Core) IV.B.1.f).(1).(e) incorporating considerations of value, equity, cost awareness, delivery and payment, and risk-benefit analysis in patient and/or population-based care as appropriate;(Core) IV.B.1.f).(1).(f) understanding health care finances and its impact on individual patients’ health decisions; and, (Core) IV.B.1.f).(1).(g) using tools and techniques that promote patient safety and disclosure of patient safety events (real or simulated). (Detail) IV.B.1.f).(2) Residents must learn to advocate for patients within the health care system to achieve the patient's and patient’s family's care goals, including, when appropriate, end-of-life goals. (Core) [The Review Committee may further specify by adding to the list of sub-competencies] IV.C. Curriculum Organization and Resident Experiences IV.C.1. The curriculum must be structured to optimize resident educational experiences, the length of the experiences, and the supervisory continuity. These educational experiences include an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events. (Core) [The Review Committee must further specify] Background and Intent: In some specialties, frequent rotational transitions, inadequate continuity of faculty member supervision, and dispersed patient locations within the hospital have adversely affected optimal resident education and effective team-based care. The need for patient care continuity varies from specialty to specialty and by clinical situation, and may be addressed by the individual Review Committee. IV.C.2. The program must provide instruction and experience in pain management if applicable for the specialty, including recognition of the signs of substance use disorder. (Core) [The Review Committee may further specify] [The Review Committee may specify required didactic and clinical experiences] IV.D. Scholarship Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 24 of 48 TAGME STUDY GUIDE Page 25 of 386 Medicine is both an art and a science. The physician is a humanistic scientist who cares for patients. This requires the ability to think critically, evaluate the literature, appropriately assimilate new knowledge, and practice lifelong learning. The program and faculty must create an environment that fosters the acquisition of such skills through resident participation in scholarly activities. Scholarly activities may include discovery, integration, application, and teaching. The ACGME recognizes the diversity of residencies and anticipates that programs prepare physicians for a variety of roles, including clinicians, scientists, and educators. It is expected that the program’s scholarship will reflect its mission(s) and aims, and the needs of the community it serves. For example, some programs may concentrate their scholarly activity on quality improvement, population health, and/or teaching, while other programs might choose to utilize more classic forms of biomedical research as the focus for scholarship. IV.D.1. Program Responsibilities IV.D.1.a) The program must demonstrate evidence of scholarly activities consistent with its mission(s) and aims. (Core) IV.D.1.b) The program, in partnership with its Sponsoring Institution, must allocate adequate resources to facilitate resident and faculty involvement in scholarly activities. (Core) [The Review Committee may further specify] IV.D.1.c) The program must advance residents’ knowledge and practice of the scholarly approach to evidence-based patient care. (Core) IV.D.2. Faculty Scholarly Activity IV.D.2.a) Among their scholarly activity, programs must demonstrate accomplishments in at least three of the following domains: (Core) Research in basic science, education, translational science, patient care, or population health Peer-reviewed grants Quality improvement and/or patient safety initiatives Systematic reviews, meta-analyses, review articles, chapters in medical textbooks, or case reports Creation of curricula, evaluation tools, didactic educational activities, or electronic educational materials Contribution to professional committees, educational organizations, or editorial boards Innovations in education Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 25 of 48 TAGME STUDY GUIDE Page 26 of 386 IV.D.2.b) The program must demonstrate dissemination of scholarly activity within and external to the program by the following methods: [Review Committee will choose to require either IV.D.2.b).(1) or both IV.D.2.b).(1) and IV.D.2.b).(2)] Background and Intent: For the purposes of education, metrics of scholarly activity represent one of the surrogates for the program’s effectiveness in the creation of an environment of inquiry that advances the residents’ scholarly approach to patient care. The Review Committee will evaluate the dissemination of scholarship for the program as a whole, not for individual faculty members, for a five-year interval, for both core and non-core faculty members, with the goal of assessing the effectiveness of the creation of such an environment. The ACGME recognizes that there may be differences in scholarship requirements between different specialties and between residencies and fellowships in the same specialty. IV.D.2.b).(1) faculty participation in grand rounds, posters, workshops, quality improvement presentations, podium presentations, grant leadership, non-peer- reviewed print/electronic resources, articles or publications, book chapters, textbooks, webinars, service on professional committees, or serving as a journal reviewer, journal editorial board member, or editor; (Outcome) IV.D.2.b).(2) peer-reviewed publication. (Outcome) IV.D.3. Resident Scholarly Activity IV.D.3.a) Residents must participate in scholarship. (Core) [The Review Committee may further specify] V. Evaluation V.A. Resident Evaluation V.A.1. Feedback and Evaluation Background and Intent: Feedback is ongoing information provided regarding aspects of one’s performance, knowledge, or understanding. The faculty empower residents to provide much of that feedback themselves in a spirit of continuous learning and self-reflection. Feedback from faculty members in the context of routine clinical care should be frequent, and need not always be formally documented. Formative and summative evaluation have distinct definitions. Formative evaluation is monitoring resident learning and providing ongoing feedback that can be used by residents to improve their learning in the context of provision of patient care or other educational opportunities. More specifically, formative evaluations help: residents identify their strengths and weaknesses and target areas that need work Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 26 of 48 TAGME STUDY GUIDE Page 27 of 386 program directors and faculty members recognize where residents are struggling and address problems immediately Summative evaluation is evaluating a resident’s learning by comparing the residents against the goals and objectives of the rotation and program, respectively. Summative evaluation is utilized to make decisions about promotion to the next level of training, or program completion. End-of-rotation and end-of-year evaluations have both summative and formative components. Information from a summative evaluation can be used formatively when residents or faculty members use it to guide their efforts and activities in subsequent rotations and to successfully complete the residency program. Feedback, formative evaluation, and summative evaluation compare intentions with accomplishments, enabling the transformation of a neophyte physician to one with growing expertise. V.A.1.a) Faculty members must directly observe, evaluate, and frequently provide feedback on resident performance during each rotation or similar educational assignment. (Core) Background and Intent: Faculty members should provide feedback frequently throughout the course of each rotation. Residents require feedback from faculty members to reinforce well-performed duties and tasks, as well as to correct deficiencies. This feedback will allow for the development of the learner as they strive to achieve the Milestones. More frequent feedback is strongly encouraged for residents who have deficiencies that may result in a poor final rotation evaluation. V.A.1.b) Evaluation must be documented at the completion of the assignment. (Core) V.A.1.b).(1) For block rotations of greater than three months in duration, evaluation must be documented at least every three months. (Core) V.A.1.b).(2) Longitudinal experiences, such as continuity clinic in the context of other clinical responsibilities, must be evaluated at least every three months and at completion. (Core) V.A.1.c) The program must provide an objective performance evaluation based on the Competencies and the specialty- specific Milestones, and must: (Core) V.A.1.c).(1) use multiple evaluators (e.g., faculty members, peers, patients, self, and other professional staff members); and, (Core) V.A.1.c).(2) provide that information to the Clinical Competency Committee for its synthesis of progressive resident Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 27 of 48 TAGME STUDY GUIDE Page 28 of 386 performance and improvement toward unsupervised practice. (Core) V.A.1.d) The program director or their designee, with input from the Clinical Competency Committee, must: V.A.1.d).(1) meet with and review with each resident their documented semi-annual evaluation of performance, including progress along the specialty-specific Milestones; (Core) V.A.1.d).(2) assist residents in developing individualized learning plans to capitalize on their strengths and identify areas for growth; and, (Core) V.A.1.d).(3) develop plans for residents failing to progress, following institutional policies and procedures. (Core) Background and Intent: Learning is an active process that requires effort from the teacher and the learner. Faculty members evaluate a resident's performance at least at the end of each rotation. The program director or their designee will review those evaluations, including their progress on the Milestones, at a minimum of every six months. Residents should be encouraged to reflect upon the evaluation, using the information to reinforce well-performed tasks or knowledge or to modify deficiencies in knowledge or practice. Working together with the faculty members, residents should develop an individualized learning plan. Residents who are experiencing difficulties with achieving progress along the Milestones may require intervention to address specific deficiencies. Such intervention, documented in an individual remediation plan developed by the program director or a faculty mentor and the resident, will take a variety of forms based on the specific learning needs of the resident. However, the ACGME recognizes that there are situations which require more significant intervention that may alter the time course of resident progression. To ensure due process, it is essential that the program director follow institutional policies and procedures. V.A.1.e) At least annually, there must be a summative evaluation of each resident that includes their readiness to progress to the next year of the program, if applicable. (Core) V.A.1.f) The evaluations of a resident’s performance must be accessible for review by the resident. (Core) [The Review Committee may further specify under any requirement in V.A.1.-V.A.1.f)] V.A.2. Final Evaluation V.A.2.a) The program director must provide a final evaluation for each resident upon completion of the program. (Core) Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 28 of 48 TAGME STUDY GUIDE Page 29 of 386 V.A.2.a).(1) The specialty-specific Milestones, and when applicable the specialty-specific Case Logs, must be used as tools to ensure residents are able to engage in autonomous practice upon completion of the program. (Core) V.A.2.a).(2) The final evaluation must: V.A.2.a).(2).(a) become part of the resident’s permanent record maintained by the institution, and must be accessible for review by the resident in accordance with institutional policy; (Core) V.A.2.a).(2).(b) verify that the resident has demonstrated the knowledge, skills, and behaviors necessary to enter autonomous practice; and, (Core) V.A.2.a).(2).(c) be shared with the resident upon completion of the program. (Core) V.A.3. A Clinical Competency Committee must be appointed by the program director. (Core) V.A.3.a) At a minimum, the Clinical Competency Committee must include three members of the program faculty, at least one of whom is a core faculty member. (Core) V.A.3.a).(1) Additional members must be faculty members from the same program or other programs, or other health professionals who have extensive contact and experience with the program’s residents. (Core) Background and Intent: The requirements regarding the Clinical Competency Committee do not preclude or limit a program director’s participation on the Clinical Competency Committee. The intent is to leave flexibility for each program to decide the best structure for its own circumstances, but a program should consider: its program director’s other roles as resident advocate, advisor, and confidante; the impact of the program director’s presence on the other Clinical Competency Committee members’ discussions and decisions; the size of the program faculty; and other program-relevant factors. Inclusivity is an important consideration in the appointment of Clinical Competency Committee members, allowing for diverse participation to ensure fair evaluation. The program director has final responsibility for resident evaluation and promotion decisions. Program faculty may include more than the physician faculty members, such as other physicians and non-physicians who teach and evaluate the program’s residents. There may be additional members of the Clinical Competency Committee. Chief residents who have completed core residency programs in their specialty may be members of the Clinical Competency Committee. V.A.3.b) The Clinical Competency Committee must: Common Program Requirements (Residency) ©2023 Accreditation Council for Graduate Medical Education (ACGME) Page 29 of 48 TAGME STUDY GUIDE Page 30 of 386 V.A.3.b).(1) review all resident evaluations at least semi-annually; (Core) V.A.3.b).(2) determine each resident’s progress on achievement of the specialty-specific Milestones; and, (Core) V.A.3.b).(3) meet prior to the residents’ semi-annual evaluations and advise the program director regarding each resident’s progress. (Core) V.B. Faculty Evaluation V.B.1. The program must have a process to evaluate each faculty member’s performance as it relates to the educational program at least annually. (Core) Background and Intent: The program director is responsible for the educational program and all educators. While the term “faculty” may be applied to physicians within a given institution for other reasons, it is applied to residency program faculty members only through approval by a program director. The development of the faculty improves the education, clinical, and research aspects of a program. Faculty members have a strong commitment to the resident and desire to provide optimal education and work opportunities. Faculty members must be provided feedback on their contribution to the mission of the program. All faculty members who interact with residents desire feedback on their education, clinical care, and research. If a faculty member does not interact with residents, feedback is not required. With regard to the diverse operating environments and configurations, the residency program director may need to work with others to determine the effectiveness of the program’s faculty performance with regard to their role in the educational program. All teaching faculty members should have their educational efforts evaluated by the residents in a confidential and anonymous manner. Other aspects for the feedback may include research o

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