The implementation of the ACGME’s current accreditation model in 2012 offered an opportunity to help catalyze, recognize, and highlight innovation in graduate medical education (GME). While the current Program Requirements already provide substantial flexibility to test new educational and assessment approaches, the ACGME recognizes the need to offer waivers from select requirements to enable further innovation. To help achieve this goal, the ACGME established Advancing Innovation in Residency Education (AIRE), a program with the dual aims of 1) enabling the exploration of novel approaches and pathways in GME, and 2) enhancing the attainment of educational and clinical outcomes through innovative structures and processes in resident and fellow education. AIRE encourages the adoption of the key principles of competency-based medical education (CBME), educational outcomes, and improving health and health care.

Any programs wishing to participate in AIRE must hold a status of Continued Accreditation. Proposals must have the written approval of the applicable certifying board(s).
Key components of an AIRE proposal include:

  • A robust assessment plan with integrated principles of CBME, specialty/subspecialty Milestones, and the ACGME’s six Core Competencies
  • Considerations for resident/fellow remediation, extension of education/training, and transfer to other education and/or training pathways
  • A comprehensive plan for faculty development, including content, delivery methods, and measuring outcomes
  • A program evaluation plan, including methods to measure the success of the innovation, its scalability, and impact on the clinical learning environment

AIRE Proposal Review Process

AIRE proposals undergo a two-step review process, the goals of which are to help programs implement a rigorous design and to assist in evaluating the effectiveness of the innovation. The ACGME will work to efficiently complete these reviews, understanding that completing all steps in the review process may take six months or longer. An overview of the process follows:

Stage 1.

The initial stage of review is completed by AIRE staff members with experience in curricular design and assessment.

AIRE staff members critically review submitted proposals to ensure that all required proposal content is addressed. This review is an iterative exchange between the AIRE team and the proposal lead intended to ensure the proposal is competency-based and outlines robust approaches to learning, teaching, faculty development, and assessment.

Once this stage is completed, and if the AIRE pathway is appropriate, the proposal advances to Stage 2 review.

Duration of Stage 1: Variable, depending on any need for revisions to the initial proposal

Stage 2.

The proposal is forwarded to the appropriate Review Committee(s) for final review and approval, revision, or rejection. This review determines whether relief will be granted for any targeted accreditation requirements. Once this review is completed, a letter documenting the outcome (approval, revision, or rejection) is sent to the proposal lead. If the proposal is approved, letters are also sent to participating programs.

With receipt of the approval letters, the innovation can launch.

Duration of Stage 2: Up to six months, based on the agenda and meeting schedule of the involved Review Committee(s).

Review additional information and a template for AIRE proposals.

Programs interested in participating in the current AIRE initiative for family medicine should email before proceeding with a proposal.

Addition of Programs to an Existing AIRE Pilot

Once an AIRE pilot has been approved, additional programs can request to participate. This requires completion of a form listing information about the program(s) wishing to join the pilot and requiring signatures from:

  • The program director (and specialty program director, if the applying program is a dependent subspecialty)
  • Designated institutional official
  • Graduate Medical Education Committee Chair

The application must also include an attestation, in the form of a letter, that states the joining program(s) will adhere to all requirements and components of the innovation as described in the approved AIRE proposal. This letter must be signed by the program director(s) of the involved program(s).

Access the form to request additional program participation in an AIRE pilot.

Annual AIRE Pilot Update

All approved AIRE pilots must submit an annual update to the ACGME. This update should address progress on the innovation’s goals, significant changes to the pilot, unanticipated barriers and implementation challenges, and the impact on residents/fellows and faculty members in the AIRE pilot program and in other programs at the institution. The update must be submitted annually to the AIRE team at the ACGME and will be reviewed by the applicable Review Committee(s). Currently, the update form is a PDF: AIRE Annual Reporting Form.

Email any questions about the AIRE program to