As the COVID-19 pandemic continues in the US, the response and needs of the graduate medical education (GME) community continue to evolve. The ACGME continues to monitor the situation to ensure that accreditation processes are responsive to the circumstances.

In all cases, Sponsoring Institutions and programs must ensure that residents and fellows can successfully complete their programs and become eligible for board certification. In recognition of this imperative, the ACGME now allows both programs and Sponsoring Institutions to request Emergency Categorization and adapt GME operations and management of educational requirements in response to local COVID-19-pandemic-related disruptions.

Program Emergency Categorization
The ACGME will allow programs facing substantial and sustained disruption of GME operations resulting from the COVID-19 pandemic to request Emergency Categorization. Such programs would need to be experiencing circumstances wherein their planned GME experiences are interrupted or altered so their residents/fellows can assist in providing care to COVID-19 patients in a local surge. Program Emergency Categorization status can only be requested after a program, in collaboration with its clinical leadership, has first exhausted all other actual and potential sources of clinical support and when disrupting the GME experience to meet patient care needs is a last resort.

The ACGME will allow programs with Program Emergency Categorization temporary relief from Program Requirements except for those pertaining to: patient and resident/fellow safety (including access to COVID-19 testing); clinical and educational work hour requirements; adequate resources for education/training; adequate supervision; and fellows functioning in their core (primary) specialty (not applicable to residency programs). Additionally, program accreditation/recognition site visit postponements can be requested.

Of special note, the ACGME will allow programs experiencing significant RSV/flu/COVID-19 surges to request Program Emergency Categorization.

All programs—even those with Program Emergency Categorization—must continue to assess residents and fellows in all six Core Competencies, and such assessments must form the basis for decisions regarding promotion to subsequent appointment levels or satisfaction of requirements for program completion. Programs should follow the principles of competency-based medical education, as described in this guidance statement, to make determinations regarding the advancement, graduation, and board eligibility of individual residents and fellows.

Applying for Program Emergency Categorization
Requests for Program Emergency Categorization for an individual program must be made through the Accreditation Data System (ADS) by the program director with approval by the designated institutional official (DIO). Once logged into ADS, access the form in the “Program” tab. For more information about accessing the Program Emergency Categorization request, visit the ADS Help Center. The number of days of a program’s Program Emergency Categorization will be counted cumulatively in each academic year (July 1-June 30). Requests can be submitted in 30-day increments for the following durations:

1 to 60 Days
The program director(s), with DIO approval, may submit a request form to declare Program Emergency Categorization for 30 days, renewable once for a total of 60 days. ACGME staff members will review the requests and notify the program director and DIO of the ACGME decision.

61 to 90 Days
At the end of the 60 days of an individual program’s Program Emergency Categorization in an academic year, the program director(s) and DIO may request an extension of Program Emergency Categorization up to 90 days in the same academic year. The request must include additional information to indicate what has been or will be done to facilitate individual learning plans for residents or fellows affected by the disruptions in their planned educational activities due to the care of patients with COVID-19. This will assist the program in applying a competency-based framework to mitigate these disruptions.

Review Committee approval is required for extension of Program Emergency Categorization status from 60 to 90 days in any academic year.

If denied this extension, the program will be notified before or upon the expiration of the 60-day term.

Programs with Program Emergency Categorization for more than 60 days in a single academic year must attest that all residents/fellows have received written information regarding their programs’ plans to ensure their ability to satisfy requirements for program completion and to become eligible for board certification.

91 Days or Longer
If COVID-19 pandemic-related disruption to GME operations persists for an individual program for more than 90 days in a single academic year, the DIO and program director(s) may request invocation of the ACGME’s policies regarding Extraordinary Circumstances (see ACGME Policies and Procedures, Section 21.00).

If the Extraordinary Circumstances policies are invoked, the Sponsoring Institution will be expected to submit plans and timelines specifying revisions to its GME programs to comply with all applicable Common and specialty-/subspecialty-specific Program Requirements; or, temporary or permanent arrangements for residents/fellows to transfer to other ACGME-accredited programs in which they can continue their education.

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Emergency Categorization Questions
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The ACGME continues to process complaints and investigate incidents of alleged non-compliance with ACGME Institutional and Program Requirements.

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For assistance accessing or entering information into the ACGME Accreditation Data System (ADS)
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