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 in order to ensure that its 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, and of the ongoing adaptation of GME operations in the pandemic, the ACGME’s framework for Emergency and Non-Emergency categorization of Sponsoring Institutions provides a process for managing accreditation concerns resulting from pandemic-related educational disruption.
Programs of Sponsoring Institutions in the Non-Emergency Category are subject to all Common and Specialty-Specific Program Requirements. All previously suspended ACGME activities (Milestones, Self-Study, Accreditation Site Visits) will resume for Sponsoring Institutions in the Non-Emergency Category and their accredited programs. For all programs, the Common Program Requirements regarding use of telemedicine/telehealth (Common Program Requirement VI.A.2.c).(1).(b)) with appropriate supervision are in effect. Ultimately, each specialty Review Committee will choose whether to continue to allow for this type of direct supervision with telemedicine in other situations.
Sponsoring Institutions that have not expressly applied for acknowledgement of Emergency categorization are by default in the Non-Emergency Category.
The ACGME may classify Sponsoring Institutions facing substantial and sustained disruption of GME operations resulting from the COVID-19 pandemic in the Emergency Category. A designated institutional official (DIO) must request emergency categorization for the Sponsoring Institution by submitting the applicable Emergency Categorization Request Form to the ACGME.
As in the previous framework, ACGME-accredited Sponsoring Institutions must comply with all ACGME Institutional Requirements throughout the term of Emergency categorization. Programs in Sponsoring Institutions with emergency categorization must continue to prioritize these areas: work hour requirements; adequate resources and training; adequate supervision; fellows functioning in their core (primary) specialty. 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 with Emergency Category status—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 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 designated institutional official (DIO) may submit a request form for acknowledgment of a pandemic emergency in a Sponsoring Institution. Institutional accreditation staff will review initial requests and first extensions for completeness and notify the DIO and institutional coordinator regarding ACGME acknowledgment.
61 to 90 Days
A DIO may submit a request form to institutional accreditation staff for a second extension of a pandemic emergency acknowledgment (up to 90 days in an academic year). The submission will include additional information about educational disruption in the Sponsoring Institution’s programs, and about COVID-19 case positivity rates, intensive care unit (ICU) 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 emergency categorization to a Sponsoring Institution. 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 this categorization after secondary review, the Sponsoring Institution will be assigned to the Non-Emergency Category upon the expiration of the 60-day term.
Sponsoring Institutions in the Emergency Category 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 substantial, pandemic-related disruption to GME operations persists in the 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.
Information on the discontinued “Three Stages of GME” is available here for archival and research purposes only.