The ACGME has developed a process under its existing Extraordinary Circumstances policy (ACGME Policy 21.0) to accommodate the need for all physicians, including residents and fellows, to care for patients to the best of their ability during the pandemic.

In circumstances where patient needs create a crisis in patient care delivery configuration, the designated institutional official (DIO), with the attestation of the Sponsoring Institution’s clinical leadership and chief executive officer, may self-declare Pandemic Emergency Status. Notice of this declaration and attestation of approval must be signed by the DIO and electronically delivered to using the form provided by the ACGME. The declaration will allow all residents/fellows to work within their institutions to care for patients.

In Sponsoring Institutions that have self-declared Pandemic Emergency Status, the requirements below remain in effect. All other Common Program Requirements and specialty-specific Program Requirements are suspended for ACGME-accredited programs in those institutions. This flexibility will allow Sponsoring Institutions and programs to increase the availability of physicians in clinical care settings.

The declaration of Pandemic Emergency Status lasts 30 days. A DIO may terminate this status in less than 30 days by notifying the ACGME via email An extension beyond 30 days is subject to review by the Institutional Review Committee. All declarations and requests for extensions will be managed by the Executive Director for the Institutional Review Committee.

This declaration applies at the institutional level and involves all residents/fellows in all specialty and subspecialty programs at the Sponsoring Institution. This status cannot be requested for a subset of the institution’s ACGME-accredited programs unless there are ACGME-accredited programs completely outside the affected service area that do not require the flexibility afforded through the declaration, e.g., a Sponsoring Institution that is a consortium functioning in multiple states.

In granting this flexibility, the ACGME, in partnership with its ACGME-accredited programs, expects the Sponsoring Institution to fully comply with the following requirements designed to protect its residents/fellows, health care teams, and patients.

The Sponsoring Institution and its programs must ensure the following:

1. Adequate Resources and Training
All residents/fellows must be trained in, and be provided with, appropriate infection protection for the clinical setting and situation. Appropriateness should consider the needs of the patient and the health care team, as well as the range of clinical care services being provided. Residents/fellows must only be assigned to participating sites that ensure the safety of patients and residents/fellows.

2. Adequate Supervision
Any resident/fellow who provides care to patients will do so under appropriate supervision for the clinical circumstance and for the level of education and experience of the resident/fellow. Faculty members are expected to have been trained in the treatment and infection control protocols and procedures adopted by their local health care settings.

3. Work Hour Requirements
The ACGME Common Program Requirements in Section VI.F. addressing work hours remain unchanged. Safety of patients and residents/fellows is the ACGME’s highest priority, and it is vital all residents and fellows receive adequate rest between clinical duties. Violations of the work hour limitations have been associated with an increase in medical errors, needle sticks, and other adverse events that might lead to lapses in infection control. Deviations in this domain could increase risks for both patients and residents/fellows.

4. Fellows Functioning in Core Specialty
Fellows in ACGME-accredited programs can function within their core specialty, consistent with the policies and procedures of the Sponsoring Institution and its participating sites, if:

  • a. they are American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board-eligible or -certified in the core specialty;
  • b. they are appointed to the medical staff at the Sponsoring Institution; and,
  • c. their time spent on their core specialty service is limited to 20 percent of their annual education time in any academic year.

All other Common Program Requirements and specialty-specific Program Requirements are suspended during the time of the declaration.

Abuse of residents, use of residents in areas in which they do not have the knowledge and skills to provide the services demanded, or failure to comply with any of the above four expectations may result in ACGME intervention.

The ACGME recognizes the serious challenges faced by the nation and its teaching hospitals. By instituting this policy clarification, the ACGME seeks to reduce the regulatory burden on Sponsoring Institutions and programs that care for patients affected by the pandemic. This flexibility is offered so that Sponsoring Institutions and programs can marshal their clinical enterprise to meet the surge of patients they must care for. The ACGME expects that this flexibility and relief will support Sponsoring Institutions and programs to protect their residents/fellows, and by doing so protect the patients under their care.

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