Question
What principles should a Sponsoring Institution apply when considering residents for clinical duties during a local extreme emergent situation* such as an epidemic that may cause a Sponsoring Institution to implement its disaster plan?

Response

The Institutional Review Committee (IRC) expects that institutional disaster plans (see Institutional Requirements, I.B.8) would address clinical duties of residents during extreme emergent situations. Designated institutional officials (DIOs) should keep in mind that all ACGME Institutional, Common, and specialty-specific Program Requirements apply in extreme emergent situations for clinical assignments within a training program and institution. The following principles may be helpful as Sponsoring Institutions consider development of these plans:

1. Residents are, first and foremost, physicians, whether they are acting under normal circumstances or in extreme emergent situations. Residents must be expected to perform according to society’s expectations of physicians as professionals and leaders in health care delivery, taking into account their degree of competence, their specialty training, and the context of the specific situation. Many residents at an advanced level of training may even be fully licensed in their state, and, therefore, they may be able to provide patient care independent of supervision.



2. Residents are students. Residents should not be first-line responders without appropriate supervision given the clinical situation at hand and their level of training and competence. If a resident is working under a training certificate from a state licensing board, they must work under supervision. Resident performance in extreme emergent situations should not exceed expectations for their scope of competence as judged by program directors and other supervisors. Residents should not be expected to perform beyond the limits of self-confidence in their own abilities. In addition, a resident must not be expected to perform in any situations outside of the scope of their individual license. Expectations for performance under extreme circumstances must be qualified by the scope of licensure, which varies by state.

Decisions regarding a resident’s involvement in local extreme emergent situations must take into account the following aspects of his/her multiple roles as a student, a physician, and an institutional employee:

• the nature of the health care and clinical work that a resident will be expected to deliver;
• resident’s level of post-graduate education specifically regarding specialty preparedness;
• resident safety, considering their level of post-graduate training, associated professional judgment capacity, and the nature of the disaster at hand;
• board certification eligibility during or after a prolonged extreme emergent situation;
• reasonable expectations for duration of engagement in the extreme emergent situation; and,
• self-limitations according to the resident’s maturity to act under significant stress or even duress.

* Extreme emergent situation: a local event (such as a hospital-declared disaster for an epidemic) that affects resident education or the work environment but does not rise to the level of an ACGME-declared disaster as defined in the ACGME Policies and Procedures, II.H.2.

FAQ19 - Process for Alerting ACGME Regarding Local Extreme Emergent Situations

Question
What steps should a Sponsoring Institution follow to alert the ACGME that a local extreme emergent situation has occurred?

Response

At the Local (Institutional) Level

1. The program directors’ (PDs) first point of contact for answers to questions regarding a local extreme emergent situation must be their GME Office/DIO.



2. The DIO should contact the Executive Director, Institutional Review Committee (ED-IRC) via telephone only if an extreme emergent situation causes serious, extended disruption to resident assignments, educational infrastructure or clinical operations that might affect the Sponsoring Institution’s or any of its programs’ ability to conduct resident education in substantial compliance with ACGME Institutional, Common, and specialty-specific Program Requirements. On behalf of the Sponsoring Institution, the DIO will provide information to the ED-IRC regarding the extreme emergent situation and the status of the educational environment for its accredited programs resulting from the emergency.



3. Given the complexity of some events, the ED-IRC may request that the DIO submit a written description of the disruptions at the Institution and details regarding activities the Institution has undertaken in response. Additional updates to this information may be requested based on the duration of the event.



4. The DIO will receive electronic confirmation of this communication with the ED-IRC which will include copies to all EDs of Residency Review Committees (RRCs).



5. Upon receipt of this confirmation by the DIO, PDs may contact their respective EDs-RRCs if necessary to discuss any specialty-specific concerns regarding interruptions to resident education or effect on educational environment.



6. PDs are expected to follow their institutional disaster policies regarding communication processes to update the DIO on the results of conversations with EDs-RRCs regarding any specialty-specific issues.



7. DIOs are expected to notify the ED-IRC when the institutional extreme emergent situation has been resolved.

1. The ED-IRC will alert EDs-RRCs when a Sponsoring Institution reports an extreme emergent situation. These communications will be included as interim correspondence in institutional and program files.



2. PDs from affected institutions may communicate directly regarding specialty-specific concerns once local extreme emergent situations have been confirmed through the ED-IRC.



3. After communication between a PD and an ED-RRC, the ED-RRC will notify the ED-IRC if there is a perception of substantive institutional accreditation issues occurring within the Institution during the event.



4. The ED-IRC will notify all EDs-RRCs when institutional extreme emergent situations have been resolved.