(Archived) Three Stages of GME During the COVID-19 Pandemic
The pressures of the COVID-19 (SARS-CoV-2) pandemic are mounting across the country. Significant numbers of patients are arriving or being transferred to teaching hospitals. In contrast, some institutions are seeing very few of these patients, but are planning for the anticipated surge of patients infected with the novel coronavirus.
These circumstances, and their continued evolution, require a new conceptual framework from which graduate medical education (GME) can effectively operate during the pandemic. Sponsoring Institutions and their participating sites are functioning at one of three stages along a continuum:
- Stage 1 – “business as usual”
- Stage 2 – increased but manageable clinical demand
- Stage 3 – crossing a threshold beyond which the increase in volume and/or severity of illness creates an extraordinary circumstance where routine care education and delivery must be reconfigured to focus only on patient care
The ACGME recognizes institutions and programs in the first two stages are also planning for the third stage of response to the pandemic. The ACGME expects:
- institutions in Stage 1 will follow all relevant accreditation requirements.
- organizations in Stage 2 will follow the Stage 2: Increased Clinical Demands Guidance for program changes to meet increasing patient needs.
- organizations in Stage 3 to consider self-declaring Pandemic Emergency Status in accordance with the procedure here.
The ACGME trusts designated institutional officials, program directors, and faculty members to make the changes necessary to care for patients during this crisis, and to protect caregivers (residents, fellows, faculty members, nurses, respiratory therapists, physician assistants) and those supporting them as they serve the nation.
| Stage 1: "Business as Usual" |
Stage 2: Increased Clinical Demands Guidance |
Stage 3: Pandemic Emergency Status Guidance |
|
| Definition |
Stage 1:
No significant disruption of patient care and educational activities; planning underway for increased clinical demands"Business as Usual" |
Some residents/fellows need to shift to patient care duties; some educational activities are suspended |
Stage 3:
Most or all residents/fellows need to shift to patient care; majority of educational activities are suspendedPandemic Emergency Status |
| Requirements in Effect |
Stage 1:
Governed by the Common and specialty-specific Program Requirements"Business as Usual" |
Stage 2:
Governed by the Common and specialty-specific Program Requirements and variances addressed in the Stage 2: Increased Clinical Demands GuidanceIncreased Clinical Demands |
Stage 3:
Governed by four overriding requirements:
Pandemic Emergency Status
|
| Flexibility |
Stage 1:
ACGME activities suspended:
"Business as Usual"
Telemedicine requirements in effect |
Stage 2:
Stage 1 plus variances addressed in the Stage 2: Increased Clinical Demands Guidance, on the following:
Increased Clinical Demands Guidance
|
Stage 3:
Stages 1 and 2 plus specialty-specific requirements waivedPandemic Emergency Status |
| ACGME Notification |
Stage 1:
"Business as Usual" |
Stage 2:
Increased Clinical Demands |
Stage 3:
Sponsoring Institutions can declare Pandemic Emergency Status; contact Institutional Review Committee Executive DirectorPandemic Emergency Status |