A Message from ACGME President and CEODr. Thomas J. Nasca

Dear Members of the Graduate Medical Education Community,

On behalf of the ACGME Board of Directors, Review Committees, and administration, I would personally like to thank you for your efforts over the past year to prepare the next generation of physicians to serve the American public. We appreciate receiving your feedback throughout the year, and wanted to update you on our latest efforts related to physician well-being, streamlining our data collection processes, and the upcoming Resident and Faculty Surveys.

At this time of year, we recognize there are additional pressures and responsibilities on us all, both personally and professionally. Based on our research¹, we must be aware of the risks for residents and fellows, especially given the higher rates of suicide during the third quarter of the academic year, beginning in January. The ACGME is introducing additional well-being tools, including resources in our Learn at ACGME online learning platform, such as apps and podcasts. These augment the well-being tools and resources posted on the ACGME website, found here, including a suicide prevention video that might be helpful in fostering discussion in your programs, and the National Academy of Medicine’s Knowledge Hub, which provides resources for clinicians and other professionals in the learning environment.

It is also important that we pay attention to the mounting evidence regarding the need for residency and fellowship programs to adhere to the ACGME’s Common Program Requirements that limit the number of work hours for residents and fellows to “no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work from home and moonlighting.” The importance of following the “80-hour work-hour limit” was emphasized in a recent article published in the New England Journal of Medicine (NEJM), entitled “National Evaluation of the Role of Discrimination, Harassment, and Abuse in Surgical Resident Well-being.”²  The article findings demonstrate that violating the work hour limits is associated with higher rates of burnout and suicidal ideation.

The ACGME will continue to focus on identifying improvements that can be made in the clinical learning environment to improve physician well-being, including helping to fund research, such as the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (the SECOND Trial).

Introduction of Common Program Requirements (Sections I-V)
From an accreditation perspective, this year has presented opportunities and challenges associated with implementing the revised Common Program Requirements in Sections I-V. The ACGME strives to balance the collection of information to meet the needs of the Review Committees, with the effort required by Sponsoring Institutions and programs to submit that information. The new information collected because of the changes in the Common Program Requirements took considerable time and effort by program directors, program coordinators, designated institutional officials, and institutional coordinators. I apologize for the challenges this placed on all of you. We anticipate that the work that you have done to describe your efforts will permit us to move many of these questions from free text responses to lists for you to pick from in future years. Dr. Lynne Kirk, the ACGME’s new Chief Accreditation Officer, is now leading our ongoing quality improvement efforts to reduce the workload required to complete the annual data updates. Those items that will remain free text will be pre-populated with the previous year’s response. We greatly appreciate the forbearance you all have demonstrated during this transition.

Upcoming Faculty and Resident Surveys
The Resident and Faculty Surveys have now been revised to align with the revised Common Program Requirements, and are scheduled for completion between January and April 2020. All active residents and fellows are expected to complete the Resident Survey. Core faculty members, excluding program directors, are expected to complete the Faculty Survey for specialty programs, and all faculty members, excluding program directors, are expected to complete the Faculty Survey for subspecialty programs. Survey results will be provided to programs that meet the 70% completion rate by the end of the academic year. As always, the results will be de-identified and only provided when sufficient numbers are available to avoid the possibility of assignment of responses to any individual resident, fellow, or faculty member.

A task force of Review Committee Chairs, ACGME Board members, residents/fellows, administrators, and a public member hired a consultant and a survey design firm to create the instruments and validate the results, including two rounds of cognitive interviews and pilot testing. We appreciate the time and contributions of the volunteers on the task force, and of the program directors, faculty members, and residents and fellows who accepted the invitation to pilot the surveys over the summer. A publication is planned describing the development and validation of these important surveys.

We look forward to seeing you at the Annual Educational Conference, taking place February 27-29, 2020 in San Diego. The conference theme of Meaning in Medicine: Compassion and Connection underscores the importance of affirming the vital bonds with patients, colleagues, and others in medical education. Sessions are planned on topics addressing diversity and inclusion, professional development, and well-being, which we hope will energize and inspire you.

Finally, I would like to thank the entire GME community for your willingness to roll up your sleeves and assist us in supporting and placing residents and fellows after the two unexpected bankruptcy events of this past summer in Philadelphia and West Virginia. Although many issues remain to be addressed, each and every resident has enrolled in a new program, thanks to your efforts!

Thank you again for the vital work you do to prepare our future physicians. All of us at the ACGME wish you a joyous holiday season, and a happy and healthy New Year.

Sincerely,

Thomas J. Nasca, MD, MACP
President and Chief Executive Officer
ACGME

---

¹Yaghmour, Nicholas A., Timothy P. Brigham, Thomas Richter, Rebecca S. Miller, Ingrid Philibert, Dewitt C. Baldwin, and Thomas J. Nasca. “Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014.” Academic Medicine 92, no. 7 (2017): 976–83. https://doi.org/10.1097/acm.0000000000001736. 

²Hu, Yue-Yung, Ryan J. Ellis, D. Brock Hewitt, Anthony D. Yang, Elaine Ooi Cheung, Judith T. Moskowitz, John R. Potts, et al. “Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training.” New England Journal of Medicine 381, no. 18 (2019): 1741–52.