The ACGME and the Residency Review Committee
2003; Elsevier BV; Volume: 10; Issue: 1 Linguagem: Inglês
10.1016/s1076-6332(03)80143-5
ISSN1878-4046
Autores Tópico(s)Diversity and Career in Medicine
ResumoThe Accreditation Council for Graduate Medical Education (ACGME) oversees the accreditation of all medical residency programs in the United States, working through 26 different residency review committees (RRCs) organized according to medical specialty. Its overarching mission is to improve the quality of health care by ensuring and continually improving the quality of graduate medical education for residents. It seeks to accomplish this by establishing standards for graduate medical education, assessing training programs continually through a process of accreditation, and promoting high-quality educational programs for trainees.Both the American Board of Radiology and Medicare recognize the ACGME as the organization that accredits residencies. Continuous ACGME accreditation is necessary in order to maintain Medicare funding of residents and fellows and to maintain their eligibility for board certification.The accreditation process is carried out separately by each of the 26 RRCs for residency programs within its specialty. Diagnostic radiology has its own RRC, which oversees the accreditation of all diagnostic radiology residency programs and ACGME-accredited subspecialty training programs and fellowships in areas of diagnostic radiology. The RRCs accredit those programs that meet or exceed the ACGME-established requirements. The RRCs determine the maximum number of residents to be admitted to each residency program. The responsibilities of RRCs also include the ongoing reassessment and reaccreditation of programs.Training programs currently eligible for accreditation through the RRC for Diagnostic Radiology include those in diagnostic radiology, vascular and interventional radiology, neuroradiology, nuclear radiology, pediatric radiology, abdominal radiology, musculoskeletal radiology, and endovascular surgical neuroradiology. Cardiothoracic radiology and breast imaging organizations have proposed accreditation of programs in their areas, but they have not yet been approved by the ACGME to start the accreditation process.The RRC is responsible for assessing and altering program requirements for the specialty it oversees. This role includes evaluation and occasional revision of the program information form (PIF), which is filled out by program directors in preparation for accreditation review. The RRC usually conducts a thorough review and revision of program requirements every 5 years. Each RRC is responsible for representing its specialty at appeals hearings when adverse actions are proposed against ACGME-accredited programs in that specialty. The RRCs evaluate proposals for new specialties in their areas. When these new proposals are deemed meritorious, the RRC helps "shepherd" them toward accreditation. The RRCs also evaluate proposals and updates of program requirements from other specialties, and thus they influence the requirements for training programs in those other specialties. This is a particularly important function of the diagnostic radiology RRC, because the program requirements for other specialties sometimes overlap with those for diagnostic radiology training.While the ACGME has a full-time staff based in Chicago, Ill, the RRC for Diagnostic Radiology meets regularly just twice a year. Its voting members include nine diagnostic radiologists and one resident in training in diagnostic radiology. In addition, a representative from the American Board of Radiology attends each meeting as a nonvoting ad hoc member. The RRC members are volunteers. The resident member serves a term of 2 years and is selected by the other current members. The other nine members are selected and nominated for 6-year terms by the American Medical Association, the American College of Radiology, and the American Board of Radiology, with each organization selecting three members.Accreditation ProcessEach ACGME-accredited training program in diagnostic radiology (including subspecialty programs) is reviewed periodically. The interval between reviews typically ranges from 1 to 5 years. When a review is scheduled, the date for a site visit is selected and communicated to the program director. The program director is then responsible for gathering pertinent information about the program. A standard PIF must be completed before the site visit. Because the PIF will be thoroughly evaluated by the site visitor and the RRC, it is extremely important that the form be completed carefully and in accordance with the accompanying instructions.Site visits are required for continued accreditation of programs and are performed by employees of the ACGME. These inspectors usually have advanced degrees (MD or PhD) and expertise in the training of residents. Their role is to confirm the information on the PIF through interviews with the program director, department chairperson, faculty members, and current residents. Site visitors typically also interview personnel outside the department of radiology, such as chairpersons of clinical departments or hospital administrators involved in residency training. The main purpose of the site visit is to gather information, and the program director and program coordinator should be prepared to answer questions. In addition, the site visitor may ask to see documents such as evaluation forms, lecture schedules, and records kept on current and previous residents, in order to confirm information supplied in the PIF. Site visitors do not decide whether to accredit a program, but their findings may influence the RRC's accreditation decision. After the visit, the site visitor produces a thorough written report, which is collated with other information regarding the program.Before a meeting of the full diagnostic radiology RRC, two RRC members are selected to review each program being evaluated for accreditation. Those members are sent the site visitor's report; the ACGME history of the program, including all previous accreditation decisions and citations for that program; correspondence between the ACGME and personnel (including the program director) regarding accreditation; and the PIF for that program. The two members evaluate this information and assess compliance of the program with the program requirements in effect at the time of the site visit. Reports from both RRC members are then returned to the ACGME office before the committee meeting.When the full diagnostic radiology RRC meets, once in the spring and once in the fall, it reviews each program scheduled for an accreditation decision. The two designated RRC members present the results of their program reviews. Each RRC member can ask questions or express opinions regarding a decision on that program. After discussing each program, the RRC votes on accreditation and records its decision. In the following weeks, a written report regarding the accreditation decision is sent to the program director.Most previously accredited programs receive continued full accreditation. If the RRC concludes that it requires additional information, a decision may be deferred until its next meeting. With this deferral, a request for additional information is sent to the program director. Other accreditation options include adverse actions, such as accreditation with warning or with proposed probation. If an adverse action is proposed, the program director may appeal the decision and present supporting information.At the time of accreditation, the RRC determines the proposed time for the next evaluation of the program. The maximum allowable time between site visits is approximately 5 years. Typically, a program in good standing and without serious shortcomings receives full accreditation with a 5-year reevaluation cycle. Shorter cycles are usually applied when serious concerns are found or citations arise from the RRC evaluation process. These concerns and citations are fully explained in the decision letter sent to the program office from the RRC.On occasion, the RRC may request a written progress report for a program it has evaluated, in order to confirm that the desired changes have been instituted as promised by the program director. When a progress report is requested, it is extremely important that the program director complete and submit it by the specified deadline.When it grants accreditation to a program, the RRC also determines the maximum number of residency positions appropriate for that program. The resident complement for each program must be commensurate with the capacity of the program to offer each resident an educational experience consistent with accreditation standards. The size of the resident complement for each program is usually based on a request by the program director for a certain number of residents. The RRC considers this number in relation to the number of full-time–equivalent radiologists on the teaching staff, the number of radiologic examinations performed at the training institution, the current accreditation status of the program, and any citations against or ongoing concerns about the program.Between accreditation site visits, it is important for the program director or the chairperson of the department to notify the RRC of any substantial changes affecting the residency program, including a change of program director or department chairperson, or of hospital affiliations or rotations. If the program director would like to increase the number of residents in the program beyond the number established at accreditation, he or she must obtain approval from the RRC before accepting additional residents into the program.Preparing for a Site VisitThe purposes of the site visit and review are for the RRC to determine the program's degree of compliance with the requirements as evidenced in the written file and for the program director to demonstrate program compliance and seek approval for major changes. A permanent file should be maintained at the program site that includes all information pertaining to accreditation of the residency program and all correspondence with the RRC office. This file should be kept separate from any personal files on the residency kept by the program director. If the director leaves the program or is replaced, the file must remain in the residency program office.The program director and coordinator should begin preparing for a site visit at least 1 year before the event, although formal notice of the visit is not usually mailed until 3 months before. The program staff should check with the RRC office to learn whether any revisions to the program requirements or to the PIF are under way.In preparation for a site visit, the following materials should be assembled: the ACGME program requirements in effect on the date of the site visit and any revised requirements due to go into effect within the year (available at the ACGME Web site); the current PIF (also available at the ACGME Web site); the completed PIF that was submitted for the last review; and the notification letter from the last full RRC review of the program and any subsequent notification letters. The person coordinating the preparation of the PIF should be responsible for these materials and should know whether the same forms and requirements are in effect as at the last visit.It is critical that one person be appointed to coordinate the preparation of the PIF. This person will be responsible for collating all parts of the form, putting them into the same format and style, and checking for accuracy and completeness. Faculty and residents should be recruited to the preparation team, with different sections of the PIF being assigned to different faculty members. A timetable for accomplishing each step and periodic meetings of the team will help guide the process. Anyone involved in the residency program should be aware of the upcoming review well before the site visit occurs.The completed PIF is the most important information provided by the program office. The PIF is the primary document in the review, both at the time of the site visit and during the RRC's evaluation. Since the RRC's action must be based on written documentation in the program file, it is essential that the file provide an accurate and complete description of the educational program and resident experiences. The PIF must demonstrate specifically how the program is meeting the program requirements, and therefore those completing the form must be familiar with those requirements. The program staff should not rely on the site visitor to be the conduit of information between them and the RRC. Each previous citation should be reviewed and addressed in the materials submitted, because reviewers will focus on previous citations and how the program has addressed previously documented deficiencies. The program director should review the finished product for thoroughness, accuracy, and adequacy and should be able to demonstrate familiarity with the document during the site visit. He or she should be prepared to answer questions about where the information came from, how numeric data were compiled, and what rotations have been changed since the last review. The final version of the PIF should be proofread, preferably by someone outside the program, to identify unclear descriptions or vague, contradictory statements. An accurate final copy should be sent to the site visitor by the date requested.On the day of the site visit, everyone who will be involved in the review should be prepared. Those scheduled for interviews with the site visitor should be reminded of the schedule, know the site visitor's name, and arrive on time. Someone should meet the site visitor at the door of the hospital. Parking should be prearranged if necessary. An office or other suitable space should be made available for the site visitor to conduct interviews, write notes, and review materials. The following materials should be readily available: all affiliation agreements, a sample resident contract, program and institutional policies and procedures, the document of residency goals and objectives, sample evaluation forms, records of procedural documentation, and anything else requested in advance. The program representative should be prepared to pull permanent resident files. The site visitor should be provided three additional copies of the PIF as is generally requested in the letter announcing the site visit, unless other instructions are received. Secretarial help should be available in case the PIF needs to be revised during the site visit. Revised pages should not be sent to the reviewer after the site visit. Common PIF errors are outlined in Figure 1 (1Program director's reference guide to ACGME and RRCs. Available at: www.acgme.org/programDir/programDir.asp. Accessed July 17, 2001Google Scholar). A list of tips for site visit preparation is provided in Figure 2.Figure 2Tips for site visit preparation.View Large Image Figure ViewerDownload (PPT)AppealsFew adverse actions are initiated by the diagnostic radiology RRC. Adverse actions that may be taken include a decrease in resident complement, withholding of accreditation, probationary accreditation, or withdrawal of accreditation. The training program can appeal to the ACGME any adverse action taken by the RRC. The appeal is put before ACGME appeal staff and a panel of three physicians selected by the training program from a list of peers recommended by the RRC or the ACGME. The appeal is based on the information available to the RRC at the time of the initial visit; program changes made after the initial site visit are not considered. About a third of the recipients of adverse actions request an appeal. The appeal panel makes a recommendation to the ACGME to sustain or rescind specific citations and the overall RRC adverse action. The ACGME makes the final decision. About one-third of appealed actions are reversed. All ACGME decisions are final. The ACGME directors meet in February, June, and September.Changing the Resident ComplementIf a program director or chairperson would like to increase the program's resident complement, a written request should be forwarded to the RRC. A change in the resident complement does not require a site visit, and the decision can usually be made by the RRC at its next meeting. When requesting an increase, the program director should provide written justification, typically citing the educational benefits of an increase. The program director should also specify the number of full-time–equivalent radiologists on staff at the training institution and all integrated institutions and the number of radiologic examinations performed at these training institutions.Circumstances occasionally require a sudden change in the resident complement, as when a trainee requests a transfer from one residency program to another for personal or professional reasons. Requests of this type can usually be handled without waiting for the RRC to meet formally. A request for a short-term increase should be submitted to the diagnostic radiology office of the ACGME in Chicago. This should be promptly followed by a written request to the diagnostic radiology RRC office. Requests for permanent increases require deliberation by the full RRC at one of its formal meetings.Accreditation of New Subspecialty AreasThe diagnostic radiology RRC also assists subspecialty organizations and groups seeking accreditation for their training programs. This is how training programs in subspecialties such as abdominal radiology and neuroradiology became eligible for ACGME accreditation. When there is interest in accrediting a specialty, a specific proposal should be forwarded to the RRC. The RRC will request written information on the justification for accreditation and the possible effect of such accreditation on programs that are already established. If the RRC agrees with the proposal, then the proposing institution or group will be asked to draft program requirements and an impact statement that will be sent to the RRC by the supporting subspecialty organization. If the RRC decides to proceed with accreditation because of the program's educational value, then a subcommittee from the RRC will help the supporting organization finalize the program requirements. This document is then sent out for comments to interested parties, including all of the 25 other RRCs, the American Medical Association, the American College of Radiology, and the American Board of Radiology. Comments returned to the diagnostic radiology RRC are evaluated at one of its meetings. If contentious issues exist, the diagnostic radiology RRC may negotiate with other organizations to resolve them. It will then adjust the program requirements as needed and send the program document to the ACGME Program Requirements Committee for evaluation. This committee makes the final decision on the eligibility of a subspecialty for ACGME accreditation. The subspecialties of cardiothoracic radiology and breast imaging are currently under consideration.ACGME InformationUp-to-date information regarding program requirements, PIFs, and proposed changes in programs accredited by the diagnostic radiology RRC and other RRCs can be accessed through the ACGME Web site. The Accreditation Council for Graduate Medical Education (ACGME) oversees the accreditation of all medical residency programs in the United States, working through 26 different residency review committees (RRCs) organized according to medical specialty. Its overarching mission is to improve the quality of health care by ensuring and continually improving the quality of graduate medical education for residents. It seeks to accomplish this by establishing standards for graduate medical education, assessing training programs continually through a process of accreditation, and promoting high-quality educational programs for trainees. Both the American Board of Radiology and Medicare recognize the ACGME as the organization that accredits residencies. Continuous ACGME accreditation is necessary in order to maintain Medicare funding of residents and fellows and to maintain their eligibility for board certification. The accreditation process is carried out separately by each of the 26 RRCs for residency programs within its specialty. Diagnostic radiology has its own RRC, which oversees the accreditation of all diagnostic radiology residency programs and ACGME-accredited subspecialty training programs and fellowships in areas of diagnostic radiology. The RRCs accredit those programs that meet or exceed the ACGME-established requirements. The RRCs determine the maximum number of residents to be admitted to each residency program. The responsibilities of RRCs also include the ongoing reassessment and reaccreditation of programs. Training programs currently eligible for accreditation through the RRC for Diagnostic Radiology include those in diagnostic radiology, vascular and interventional radiology, neuroradiology, nuclear radiology, pediatric radiology, abdominal radiology, musculoskeletal radiology, and endovascular surgical neuroradiology. Cardiothoracic radiology and breast imaging organizations have proposed accreditation of programs in their areas, but they have not yet been approved by the ACGME to start the accreditation process. The RRC is responsible for assessing and altering program requirements for the specialty it oversees. This role includes evaluation and occasional revision of the program information form (PIF), which is filled out by program directors in preparation for accreditation review. The RRC usually conducts a thorough review and revision of program requirements every 5 years. Each RRC is responsible for representing its specialty at appeals hearings when adverse actions are proposed against ACGME-accredited programs in that specialty. The RRCs evaluate proposals for new specialties in their areas. When these new proposals are deemed meritorious, the RRC helps "shepherd" them toward accreditation. The RRCs also evaluate proposals and updates of program requirements from other specialties, and thus they influence the requirements for training programs in those other specialties. This is a particularly important function of the diagnostic radiology RRC, because the program requirements for other specialties sometimes overlap with those for diagnostic radiology training. While the ACGME has a full-time staff based in Chicago, Ill, the RRC for Diagnostic Radiology meets regularly just twice a year. Its voting members include nine diagnostic radiologists and one resident in training in diagnostic radiology. In addition, a representative from the American Board of Radiology attends each meeting as a nonvoting ad hoc member. The RRC members are volunteers. The resident member serves a term of 2 years and is selected by the other current members. The other nine members are selected and nominated for 6-year terms by the American Medical Association, the American College of Radiology, and the American Board of Radiology, with each organization selecting three members. Accreditation ProcessEach ACGME-accredited training program in diagnostic radiology (including subspecialty programs) is reviewed periodically. The interval between reviews typically ranges from 1 to 5 years. When a review is scheduled, the date for a site visit is selected and communicated to the program director. The program director is then responsible for gathering pertinent information about the program. A standard PIF must be completed before the site visit. Because the PIF will be thoroughly evaluated by the site visitor and the RRC, it is extremely important that the form be completed carefully and in accordance with the accompanying instructions.Site visits are required for continued accreditation of programs and are performed by employees of the ACGME. These inspectors usually have advanced degrees (MD or PhD) and expertise in the training of residents. Their role is to confirm the information on the PIF through interviews with the program director, department chairperson, faculty members, and current residents. Site visitors typically also interview personnel outside the department of radiology, such as chairpersons of clinical departments or hospital administrators involved in residency training. The main purpose of the site visit is to gather information, and the program director and program coordinator should be prepared to answer questions. In addition, the site visitor may ask to see documents such as evaluation forms, lecture schedules, and records kept on current and previous residents, in order to confirm information supplied in the PIF. Site visitors do not decide whether to accredit a program, but their findings may influence the RRC's accreditation decision. After the visit, the site visitor produces a thorough written report, which is collated with other information regarding the program.Before a meeting of the full diagnostic radiology RRC, two RRC members are selected to review each program being evaluated for accreditation. Those members are sent the site visitor's report; the ACGME history of the program, including all previous accreditation decisions and citations for that program; correspondence between the ACGME and personnel (including the program director) regarding accreditation; and the PIF for that program. The two members evaluate this information and assess compliance of the program with the program requirements in effect at the time of the site visit. Reports from both RRC members are then returned to the ACGME office before the committee meeting.When the full diagnostic radiology RRC meets, once in the spring and once in the fall, it reviews each program scheduled for an accreditation decision. The two designated RRC members present the results of their program reviews. Each RRC member can ask questions or express opinions regarding a decision on that program. After discussing each program, the RRC votes on accreditation and records its decision. In the following weeks, a written report regarding the accreditation decision is sent to the program director.Most previously accredited programs receive continued full accreditation. If the RRC concludes that it requires additional information, a decision may be deferred until its next meeting. With this deferral, a request for additional information is sent to the program director. Other accreditation options include adverse actions, such as accreditation with warning or with proposed probation. If an adverse action is proposed, the program director may appeal the decision and present supporting information.At the time of accreditation, the RRC determines the proposed time for the next evaluation of the program. The maximum allowable time between site visits is approximately 5 years. Typically, a program in good standing and without serious shortcomings receives full accreditation with a 5-year reevaluation cycle. Shorter cycles are usually applied when serious concerns are found or citations arise from the RRC evaluation process. These concerns and citations are fully explained in the decision letter sent to the program office from the RRC.On occasion, the RRC may request a written progress report for a program it has evaluated, in order to confirm that the desired changes have been instituted as promised by the program director. When a progress report is requested, it is extremely important that the program director complete and submit it by the specified deadline.When it grants accreditation to a program, the RRC also determines the maximum number of residency positions appropriate for that program. The resident complement for each program must be commensurate with the capacity of the program to offer each resident an educational experience consistent with accreditation standards. The size of the resident complement for each program is usually based on a request by the program director for a certain number of residents. The RRC considers this number in relation to the number of full-time–equivalent radiologists on the teaching staff, the number of radiologic examinations performed at the training institution, the current accreditation status of the program, and any citations against or ongoing concerns about the program.Between accreditation site visits, it is important for the program director or the chairperson of the department to notify the RRC of any substantial changes affecting the residency program, including a change of program director or department chairperson, or of hospital affiliations or rotations. If the program director would like to increase the number of residents in the program beyond the number established at accreditation, he or she must obtain approval from the RRC before accepting additional residents into the program. Each ACGME-accredited training program in diagnostic radiology (including subspecialty programs) is reviewed periodically. The interval between reviews typically ranges from 1 to 5 years. When a review is scheduled, the date for a site visit is selected and communicated to the program director. The program director is then responsible for gathering pertinent information about the program. A standard PIF must be completed before the site visit. Because the PIF will be thoroughly evaluated by the site visitor and the RRC, it is extremely important that the form be completed carefully and in accordance with the accompanying instructions. Site visits are required for continued accreditation of programs and are performed by employees of the ACGME. These inspectors usually have advanced degrees (MD or PhD) and expertise in the training of residents. Their role is to confirm the information on the PIF through interviews with the program director, department chairperson, faculty members, and current residents. Site visitors typically also interview personnel outside the department of radiology, such as chairpersons o
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