ACGME Global Services, a department of the ACGME, was created to advance the ACGME Mission by working with global entities to enhance the quality of resident and fellow physicians’ education. Through this series, The ACGME and Global Health seeks to engage the global medical and health care communities in conversations on challenges facing global health that transcends borders.
This post includes input from ACGME leaders from recent interviews.
Born of a request by Singapore to strengthen local post-graduate medical education (PGME) via accreditation, the ACGME launched a pilot program in 2009 to test whether its accreditation model would work outside of the United States. The pilot was extended to the Middle East a few years later.
Deemed successful internally and among stakeholders, the pilot was transformed into a formal body for PGME accreditation outside of the US – ACGME International, LLC. Continual growth of international accreditation activities required independence in setting standards and requirements, as well as making accreditation decisions, to ensure that global standards and cultural contexts are objectively assessed without a US-centric bias. Thus ACGME International (ACGME-I) became its own 501(c)(3) in 2019, operating cooperatively with ACGME, yet governed by its own Board of Directors. Today it accredits 188 residency and fellowship programs in 22 Sponsoring Institutions across 12 countries.
While ACGME-I was indeed a success, it became evident that its accreditation model was “not the solution for everyone who came to us,” explained ACGME President and Chief Executive Officer Thomas J. Nasca, MD, MACP. He noted that many incoming requests were for assistance in developing educational systems and systemic infrastructure – such as creating a domestic accreditation system that fits within the requesting country’s existing PGME structures.
The creation of ACGME Global Services demonstrates the two-pronged approach in fulfilling the ACGME Mission across borders, separating accreditation (ACGME-I) from advisory services (Global Services) to protect against any actual or apparent conflicts of interest.
“And indeed, Singapore, our first excursion outside the United States, has now asked us to consult with them to develop their own accreditation system based on ours,” added Dr. Nasca, describing the assistance Global Services is providing Singapore in developing its homegrown Accreditation of Postgraduate Medical Education Singapore (APMES) system.
Contextualize and Localize PGME
ACGME Global Services now serves as an advisory arm for the ACGME’s global initiatives, which help fulfill the ACGME Mission by working with global stakeholders to jointly advance the state of PGME across national boundaries.
“The idea of a healthy population is something that transcends geography,” said ACGME Chief Financial and Administrative Officer and Executive Vice President of ACGME Global Services John Ogunkeye, MS.
The key approaches for Global Services, according to Mr. Ogunkeye, involve research, listening, understanding, respecting, and collaborating with local stakeholders, in order to truly grasp the local situation and sensitivities required for assessing needs. From there, Global Services is able to “contextualize and localize,” while maintaining standards in education and training so physicians anywhere in the world will “have the same kind of fundamental skills” to provide care.
Strengthening physician education and training globally is also important from a US point of view, noted Mr. Ogunkeye, adding that a quarter of US physicians are international medical graduates (IMGs). “There’s a [health] worker shortage in the US just like there is in every part of the world, so the US needs to recognize the need [for] doctors coming here for training or to work.”
“It’s about partnership,” emphasized Mr. Ogunkeye, describing the role of Global Services as a cultural bridge” between the US and the world, and vice versa. “It’s not just a one-way street, it really is bidirectional.”
A Convener for Global PGME
Global Services endeavors to be a convenor of like-minded entities around the world, to share knowledge and participate as a contributing member of the global physician education community. Mr. Ogunkeye envisions Global Services as a “clearing house” for information sharing to promote global PGME standards.
“We believe over time, there will be consolidation of oversight of physician education around the world,” added Dr. Nasca, “and the ACGME aspires to be part of that effort.”
Mr. Ogunkeye reemphasized the vital importance of partnership and collaboration in this effort to create truly global conversations that value contributions from all stakeholders, without notions of hierarchy and patronization. “It's not the American system that prevails, it’s the world system that prevails,” he stressed. “Ultimately, I would like Global Services to be a trustworthy intermediary of developments in the PGME world.”
Empowering Excellence in Global PGME
Mr. Ogunkeye summed up the value statement: “I think what we, Global Services, are about is empowering excellence in medical education worldwide.”
Indeed, the overarching raison d’etre for Global Services is to fulfill the ACGME Mission by sharing knowledge and experience regardless of geographic borders.
“We have a professional responsibility to do that if we have the knowledge that is of benefit to others outside the United States to improve health and health care,” affirmed Dr. Nasca.
The goal of this content series is to provoke discussion about issues that concern the global PGME community, enabling critical conversation that engages with stakeholders across borders, disciplines, and perspectives. We invite comments by email (global@acgme.org) and through Twitter and LinkedIn (with the hashtag #ACGMEGlobalServices). We also seek external voices in future posts in the ACGME and Global Health Blog series; email us if you would like to participate.