Improving Site Visit Reports for High-Performing Residency Programs Without Citations

Abstract

As the Accreditation Council for Graduate Medical Education (ACGME) transitions to the Next Accreditation System (NAS), there is value in exploring the elements of the current accreditation process for opportunities for improvement. A key function of the accreditation process, both in the current system and in the NAS, is to assess compliance with the ACGME program and institutional requirements. In the current accreditation system, the ACGME's review of individual residency education programs is based on the Program Information Form prepared prior to the site visit. In the NAS, the review will be based on data annually submitted to the ACGME, and brief documentation submitted in preparation for a 10-year self-study visit. After each site visit, the ACGME field representative completes an objective, narrative site visit report relating his or her findings. This report is submitted to the Residency Review Committee (RRC), and together with the information provided by the program and other data (such as the ACGME Resident Survey, and in many specialties, operative and experience logs), it is used to make the accreditation decision. Areas of noncompliance receive citations by the RRC. The best programs are granted Full Accreditation without citations on the basis of substantial compliance with all standards. The Site Visit Report During the past 10 years the site visit report has changed significantly. The reports started as open-ended narrative documents. To ensure that compliance with all program requirements was addressed in the report, the ACGME developed a consistent format that followed the order of the program requirements and developed standard forms for each specialty and subspecialty. The most recent versions of those forms provided forced-choice responses and areas where the field representative could add narrative to provide clarification or added details. This format facilitated the identification of all areas in which a program did not meet the accreditation requirements, yet it was less effective in allowing the field representative to identify program strengths or innovative practices. The heavily formatted reports made it possible for a site visit report to indicate full compliance with all program requirements yet appear rather sterile and devoid of the specific information about the program that would allow an RRC to feel comfortable giving a program the longest possible cycle length.