ACGME | Accreditation Council for Graduate Medical Education

MEMORANDUM

TO:

Residents and Fellows in ACGME-accredited Programs

FROM:

Emmanuel Cassimatis, MD, Chairman, ACGME
David Leach, MD, Executive Director, ACGME

RE:

The ACGME’s Role in Promoting an Effective Learning Environment, Safe Patient Care and Resident Safety and Well-Being

DATE:

July 29, 2005

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) established common duty hour standards for all accredited programs. The standards are part of a broader approach to promote resident learning, safe patient care and resident safety and well-being. The ACGME accredits more than 8,000 US residency programs that collectively train nearly 100,000 residents (more information is found in the attached summary). The common duty hour standards apply to all programs in the 120 ACGME-accredited specialties and subspecialties. They include:

An 80-hour weekly limit, averaged over four weeks.
An adequate rest period, which should consist of 10 hours of rest between duty periods.
A 24-hour limit on continuous duty, with up to six added hours for continuity of care and education.
One day in seven free from patient care and educational obligations, averaged over four weeks.
In-house call no more than once every three nights, averaged over four weeks.
Some specialties have more restrictive standards, reflecting patient care and educational demands.
Programs must ensure that reducing resident hours will not reduce educational time in order to meet patient service obligations.

The ACGME is working with the directors of your residency programs and with the designated institutional official and leadership of the institutions that sponsor them to ensure that your education complies with the ACGME standards. The ACGME monitors compliance with the duty hour and other standards through various means, including:

Interviews with program directors, staff and residents during the periodic accreditation site visit.
Confidential Internet resident surveys for all programs with four or more residents.
Education of residents, program directors and other stakeholders about the accreditation standards.
A complaint management process to receive and follow up on complaints about alleged violations of the accreditation standards.

In the past two years, the ACGME has used an expedited process for following-up instances of non-compliance with the duty hour standards. In this process, the ACGME may ask programs to re-administer the resident survey and request progress reports and actions plans from cited programs that demonstrate how they have achieved compliance with the standards. Ongoing failure to comply with the standards will result in adverse accreditation actions.

The ACGME recognizes that residents play a vital role in the health care system. At the same time, the primary purpose of residency is educational, and your program and its sponsoring institution need to provide you with an environment conducive to learning. The ACGME will partner with you, programs and teaching institution to ensure consistent application and enforcement of its accreditation standards, including the standards that limit resident duty hours.

The attached summary offers you a concise overview of the ACGME’s role and function. More information is available from our Web site (http://www.acgme.org).

CC:	Program Directors, ACGME-Accredited Programs Executive Directors Residency Review Committees Institutional Review Committee