This summary describes Sponsoring Institution Emergency Categorization. Information about Program Emergency Categorization can be found here.

As the COVID-19 pandemic continues in the US, the response and needs of the graduate medical education (GME) community evolve. The ACGME monitors the situation to ensure 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 Sponsoring Institutions and programs to request Emergency Categorization and adapt GME operations and management of educational requirements in response to local COVID-19 pandemic-related educational disruptions.

Sponsoring Institution Emergency Categorization
The ACGME allows Sponsoring Institutions facing substantial and sustained disruption of GME operations resulting from the COVID-19 pandemic to request Sponsoring Institution Emergency Categorization. A designated institutional official (DIO) must request Sponsoring Institution Emergency Categorization by submitting the applicable Emergency Categorization Request Form to the ACGME.

ACGME-accredited Sponsoring Institutions must comply with all ACGME Institutional Requirements throughout the term of their Sponsoring Institution Emergency Categorization. Programs in Sponsoring Institutions with this Emergency Categorization must continue to prioritize these areas: 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). These obligations to ensure safety extend to the protection of faculty members, residents, and fellows who inform Sponsoring Institutions and programs of health conditions or impairments that are likely to be associated with a high risk of morbidity or mortality in the event of COVID-19 infection.

Additionally, all programs-even those in Sponsoring Institutions with Sponsoring Institution 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.

The days of a Sponsoring Institution’s Emergency Category status will be counted cumulatively in each academic year (July 1-June 30). A Sponsoring Institution’s first request for Sponsoring Institution Emergency Categorization in a given academic year should be submitted to the ACGME using the Request Form for 1-30 Days.

1 to 60 Days
A DIO may submit a request for Sponsoring Institution Emergency Categorization for one to 30 days, renewable once for a total of 60 days. ACGME Institutional accreditation staff members will review initial requests and first extensions for completeness and notify the DIO and institutional coordinator regarding ACGME acknowledgment of the request.

61 to 90 Days
At the end of the 60 days of Sponsoring Institution Emergency Categorization in an academic year, the DIO may request an extension of Sponsoring Institution Emergency Categorization up to 90 days in the same academic year. The request must include information about educational disruption in the Sponsoring Institution’s accredited programs, and about COVID-19 case positivity rates, intensive care unit bed availability, and elective procedures relevant to the Sponsoring Institution’s participating sites.

The ACGME sets thresholds to determine whether the submitted information is sufficient to grant Sponsoring Institution Emergency Categorization. If thresholds are not met or exceeded, the DIO may use the form to provide additional information for secondary review by the Institutional Review Committee.

If denied Sponsoring Institution Emergency Categorization after secondary review, the Sponsoring Institution will be notified before or upon the expiration of the 60-day term.

Sponsoring Institutions with Sponsoring Institution Emergency Categorization for more than 60 days in an 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 a Sponsoring Institution for more than 90 days in an academic year, the DIO 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.