ACGME Sponsoring Institution and Program Emergency Categorization

Question: Does the ACGME allow any special accommodations for Sponsoring Institutions and/or programs experiencing disruptions related to the COVID-19 pandemic?

The ACGME provides a process for both Sponsoring Institutions and programs facing substantial and sustained disruption of GME operations resulting from the COVID-19 pandemic to request Emergency Categorization. This process offers relief from some, but not all, ACGME accreditation requirements. For more information on the process, follow the links below:

Sponsoring Institution Emergency Categorization
Program Emergency Categorization

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ACGME Program/Institutional Requirements

The Pandemic and Accreditation Decisions

Question: How will the Review Committees consider the impact of the pandemic on programs in making future accreditation decisions?

During the Accreditation Data System (ADS) Annual Update, programs are able to explain how they were impacted in the prior academic year by the COVID-19 pandemic in the “Major Changes and Other Updates” section. Review Committees will determine the potential accreditation impact of disruptions in Sponsoring Institution or program activities resulting from the pandemic.

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The Pandemic and Program Requirements

Question: Can fellows be assigned to act as attending physicians?

For Sponsoring Institutions and programs in Emergency Categorization fellows may act as attending physicians if the institution or program needs them to meet patient care needs up to 20 percent of each academic year.

The fellowship program director and the designated institutional official (DIO) must approve any request for fellows to work as an attending physician in their primary specialty area.

The program director must maintain a record of the time fellows spend working as an attending physician in their primary specialty.

For Sponsoring Institutions and programs not in Emergency Categorization, fellows may only act as an attending physician in their primary specialty in the subspecialties for which the Program Requirements permit this. These are listed below. Consult the pertinent subspecialty Program Requirements to determine the time allowed for fellows to spend in their primary specialty.

  • Adult Reconstructive Orthopaedic Surgery
  • Clinical Informatics
  • Complex Family Planning
  • Craniofacial Plastic Surgery
  • Emergency Medical Services
  • Female Pelvic Medicine and Reconstructive Surgery
  • Foot and Ankle Orthopaedic Surgery
  • Gynecologic Oncology
  • Hand Surgery
  • Health Care Administration, Leadership and Management
  • Maternal-Fetal Medicine
  • Medical Toxicology
  • Musculoskeletal Oncology
  • Neurocritical Care
  • Neurotology
  • Orthopaedic Sports Medicine
  • Orthopaedic Surgery of the Spine
  • Orthopaedic Trauma
  • Pediatric Dermatology
  • Pediatric Orthopaedic Surgery
  • Pediatric Otolaryngology
  • Pediatric Urology
  • Reproductive Endocrinology and Infertility
  • Undersea and Hyperbaric Medicine

The Program Requirements for each of these subspecialties specify how much independent practice is permitted.

Question: Can residents/fellows be reassigned from their previously scheduled clinical rotations and other assignments?

Reassignments can occur to other rotations or forms of clinical work with the approval of the program director and the DIO.

Prior to starting the reassignment, a resident/fellow must receive appropriate safety and clinical training for the new setting.

During such activity, the resident/fellow must have appropriate supervision at all times.

During such activity, the resident/fellow must adhere to work hour requirements.

During such activity, fellows can function as attending physicians in their core specialty only in those subspecialties where the Program Requirements allow this.

Question: If residents’/fellows’ schedules need to change because of the pandemic, do those changes need to be reflected on the block diagram submitted by the program in ADS?

No, but the program should internally track each actual assignment served by each resident/fellow, regardless of the number of days, weeks, or months of each assignment.

The block diagram is often confused with the resident/fellow rotation schedule. The block diagram is a map of the planned rotations (or other educational experiences) for all residents/fellows in a given post-graduate year. A rotation schedule depicts the actual sequence of rotations (or other educational experiences) for each individual resident/fellow. The ACGME requires programs to annually submit a block diagram, but requests submission of rotation schedules only rarely and for very specific reasons. Refer to the Block Diagram section of the Program Director’s Guide (Residency or Fellowship), as applicable for further clarification.

Question: Given the pandemic’s impact on the clinical learning environment and programs’ regular educational curricula, can residents/fellows successfully complete their education and training without completing all planned educational experiences?

The decision to graduate a resident/fellow is made by the program director, with input from the Clinical Competency Committee (CCC). Such decisions are based on that individual’s Milestones assessments, indicating the resident’s/fellow’s ability to perform the medical, diagnostic, and/or surgical care considered essential for the area of practice.

The determination of whether or not a resident/fellow can graduate as previously scheduled is the responsibility of the program director. As such, the determination can be made even if the curriculum as originally planned is not completed. However, an extension of the educational program may be necessary if the program director determines an individual has not demonstrated the competence necessary for autonomous practice and documentation of eligibility for the certifying or qualifying board examination.

Further guidance on assessing the competence of residents/fellows can be found in the ACGME’s Guidance Statement on Competency-Based Medical Education during COVID-19 Residency and Fellowship Disruptions.

The ACGME has also developed several transition toolkits that can serve as resources to support learners at specific stages in their career. See: Transitions in Medical Education.

Question: How should programs handle residents/fellows who have not been able to complete required rotations, clinic visits, operative cases, or other procedures due to changes related to COVID-19?

At some Sponsoring Institutions, clinical education experiences may not be available or may be reduced for a period of time resulting from local COVID-19 status. This may include rotations, clinics or clinic visits, operative cases, and other procedures.

The program director will have to consider the circumstances and along with the Clinical Competency Committee (CCC), assess the readiness of each resident/fellow to progress to the next level of education or successfully complete the program. The ACGME’s Guidance Statement on Competency-Based Medical Education during COVID-19 Residency and Fellowship Disruptions recommends that before the mid-year semi-annual feedback, each residency and fellowship program’s CCC review the current status and progress of residents/fellows scheduled to graduate in June. By no later than December 31 of the graduation year, program leadership should assess the current state of progress in the program for each individual resident/fellow and then work with each resident/fellow not meeting particular milestones to create an individual learning plan (ILP) for the remaining time in the program. The ILP should include an identification of the remaining competency gaps. The individual and the program should have the opportunity to address those gaps with an increase of observations and feedback before the end of the academic year. (see ACGME Common Program Requirement V.A.1.d)).

The ACGME has also developed several transition toolkits that can serve as resources to help support learners at specific stages in their career. See: Transitions in Medical Education.

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Participating Sites

Question: What needs to be in place for a program’s residents/fellows to work in another hospital if that hospital has never been used by the program for required rotations previously?

If a site becomes one that routinely provides an educational experience that is required for all residents/fellows for one month or longer in duration, the program director must designate that hospital as an additional participating site in the program’s ADS record.

See Participating Sites and PLAs in the Common Program Requirements:
I.B. Participating Sites to I.B.4.

Each participating site must have a faculty member appointed by the program director as the site director who is accountable for resident/fellow education at that site, in collaboration with the program director. The program must monitor the clinical learning and working environment in that hospital, including resident/fellow work hours, resident/fellow supervision, and provisions for resident/fellow safety.

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Supervision and Telehealth

Question: What is and what is not allowable relative to supervision and the use of telehealth and telemedicine during the pandemic crisis?

Each Review Committee chose whether to continue to allow for this type of direct supervision with telemedicine in other situations. This is specified in the applicable specialty- or subspecialty-specific Program Requirements.

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Work Hour Requirements

Question: Are work hour requirements being loosened or modified?

There will be no change to existing requirements limiting residents to 80 hours per week or to any of the requirements in Section VI.F. of the Common Program Requirements. A strong evidence base has been established demonstrating that adherence to these requirements increases resident safety and well-being.

These dimensions are especially important in the care of patients in the current environment.

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ACGME Required Accreditation and Recognition Activities


Question: Do programs need to do the Self-Study?

Programs will not be required to complete a Self-Study until further notice and program Self-Study dates have been updated to “postponed” in ADS. Institutional Self-Studies will proceed according to the Institutional Review Committee’s announced plan. At this time, the program Self-Study is not connected to the Institutional Self-Study. Visit the program Self-Study web page for additional information.

Question: Can programs still perform Self-Study activities?

Yes. The deferral does not prohibit program Self-Study activities. The ACGME encourages programs to incorporate the Self-Study into their Annual Program Evaluation process and track ongoing progress and program improvements as outlined in the Common Program Requirements. Click here for guidance on performing the program Self-Study.

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Site Visits - Accreditation

Question: How are ACGME accreditation and recognition site visits conducted?

Since June 2020, accreditation and recognition site visits have been conducted primarily using remote technology. Currently and going forward, site visits may be performed using remote technology or in an in-person format.

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Resident/Fellow Issues

Question: What is the ACGME’s guidance regarding residents/fellows refusing assignments related to COVID-19 patient care?

As stated in another FAQ, assignments and reassignments of residents/fellows to other rotations or forms of clinical work can occur at the direction and approval of the program director and the DIO. Such assignments would occur depending on local circumstances to address care and support needs, likely as a result of the COVID-19 crisis. Per the ACGME’s guidance on this subject, prior to starting such an assignment, residents/fellows must receive appropriate safety and clinical training specific to the assignment and setting, and during the assignment, they must have appropriate supervision at all times and must adhere to work hour requirements. As an accreditor, the ACGME cannot and does not intervene in disputes between individual residents/fellows and their programs, but the ACGME has established and reiterated these requirements to convey clearly that these must be followed to protect patients, residents/fellows, and supervising physicians, as well as the education of the residents/fellows. Violation of these requirements can result in negative consequences for all involved, including at the accreditation level at the time of the program’s next review.

Question: Can a program’s residents/fellows be asked to give up or postpone vacation time in order to help with the pandemic?

Resident/fellow vacation time is dictated by the policies of the Sponsoring Institution, consistent with applicable laws, and is addressed in the contract/agreement of appointment. A decision to ask a resident/fellow to give up or postpone vacation would need to be consistent with institutional policy and with the terms of the contract/agreement of appointment.

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Other Miscellaneous

Complement Increases

Question: How will the ACGME handle temporary complement increase requests to accommodate residents/fellows who are not able (for any reason) to graduate as previously scheduled?

Requests for temporary complement increases should be submitted to the specialty Review Committee via ADS. More information on the temporary complement increase process can be accessed in each specialty’s section of the ACGME website.

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Contact Us:

General Inquiries

Emergency Categorization Questions
Sponsoring Institutions

Office of Complaints
The ACGME continues to process complaints and investigate incidents of alleged non-compliance with ACGME Institutional and Program Requirements.

Accreditation Data System (ADS)
For assistance accessing or entering information into the ACGME Accreditation Data System (ADS)
email or find a customer service representative