Accreditation Council For Graduate Medical Education Requirements Research Articles

The Expanding Role of Designated Institutional Officials in Graduate Medical Education

Abstract The Accreditation Council for Graduate Medical Education (ACGME) plays a pivotal role in ensuring the quality of graduate medical education (GME) training across the United States. Central to the success of this mission are designated institutional officials (DIOs), who usually serve as chief GME officers within the ACGME-accredited sponsoring institutions (SIs). Despite the critical role of DIOs, the qualifications, level of administrative support, and responsibilities of DIOs are not defined and vary significantly among SIs. Although responsibilities mandated by ACGME Institutional Requirements provide a framework, the actual scope of work of DIOs often extends far beyond what is outlined in the ACGME Institutional Requirements, involving collaboration with a wide variety of institutional stakeholders and harnessing the GME enterprise to achieve institutional goals. Nearly all DIOs face a multitude of challenges, including adapting to new ACGME requirements and initiatives, addressing resident and fellow wellness concerns, promoting health equity, nurturing scholarly endeavors, and advocating for their residents and fellows. Additionally, emerging technologies and innovations as well as the changing financial climate for SIs and the health care facilities that host GME learners can present both educational opportunities and new challenges for DIOs in ensuring trainees are prepared for their roles as the next generation of physicians. As the health care landscape evolves, DIOs will continue to play a vital role in shaping the educational experiences of physicians in training while balancing institutional priorities and ensuring high-quality patient care.

Education Research: Establishing a Postgraduate Year-1 Director Enhances Well-Being for Adult Neurology Residents.

Adult neurology clinical trainees in Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs spend their postgraduate year (PGY)-1 within the internal medicine department, potentially causing a perceived disconnect with their neurology program. Our Adult Neurology Clinical Competency Committee found this disconnect may decrease resident well-being. We hypothesized implementing a novel PGY-1 Director role focusing on unique aspects of this first year would improve resident well-being and connection to the neurology program. The PGY-1 Director was established as an associate program director in the adult neurology residency program with goals to improve wellness, advocacy, compliance with ACGME requirements, education, and communication. Anonymous surveys compared preintervention (before the PGY-1 Director role) with postintervention resident opinions on PGY-1 experience, assessing wellness, burnout, and perception of advocacy. A total of 15 (75%) preintervention residents and 23 (96%) postintervention residents completed the study surveys. 53.7% of preintervention residents agreed or strongly agreed to feeling burned out, while only 17.4% of postintervention residents agreed they felt burned out and none strongly agreed. Significant improvement occurred in feeling supported clinically and emotionally and feeling validated. Most postintervention residents felt the PGY-1 Director was valuable and directly led to positive change. The relationship between the neurology and internal medicine departments was improved. A dedicated PGY-1 Director position can improve trainee wellness outcomes and relationships between preliminary and matched departments. This mutually benefits both programs but requires substantial resources. We propose this as a best practice when feasible for ACGME programs with the following suggestions: (1) provide dedicated full-time equivalent time, (2) meet with preliminary program leadership regularly, (3) meet with PGY-1 trainees during orientation and at least quarterly, (4) serve as an advocate, and (5) facilitate mentorship in areas of interest.

Comparing Graduating Plastic Surgery Residents' Case Logs With Accreditation Council for Graduate Medical Education Requirements, Content at National Meetings, and In-Service Examination Test Items.

The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings. Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019-2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison. The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery. The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.

Early Immersion in Team-Based Event Review: Experiential Patient Safety Education for PGY 1 Internal Medicine Residents.

In recent years, there has been a national push to incorporate high-fidelity quality improvement and patient safety (QIPS) education into physician training programs. In fact, integration of robust patient safety education became an Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirement for residency programs in 2017. We developed a curriculum to not only fulfill the ACGME's requirement but also provide PGY 1 internal medicine residents with the skills needed to become active participants in ongoing patient safety work throughout their training and careers. Our patient safety curriculum was woven into residents' existing protected educational time and supported by a standardized facilitator guide and participant workbook. It combined didactic prework with the review of recent near-miss or low-harm patient safety events, empowering residents to identify root causes and propose interventions. We successfully delivered our patient safety curriculum to 80 PGY 1 residents over the course of 2 academic years. Residents rated the curriculum as a valuable educational experience, and the event reviews they completed met most of the criteria for high-quality patient safety reviews according to the Strong String Assessment. Implementation of this standardized curriculum has allowed us to reliably and consistently incorporate experiential patient safety education into the first year of training for internal medicine residents. Unlike purely didactic sessions, our curriculum encourages active learning, building muscle memory for event reviews that enables future engagement in patient safety activities.

The Impact of Updated ACGME Program Requirements for Radiation Oncology Residencies

In 2022, the Accreditation Council for Graduate Medical Education (ACGME) made several changes to the common program requirements for radiation oncology, which may be difficult for some residency programs to meet in their present state. Programs are currently expected to have 1.5 clinical physician faculty members per resident. Additionally, the sponsoring institution must sponsor at least one medical oncology program and sponsor or have affiliations with ACGME-accredited surgical oncology and pathology programs. We sought to investigate if radiation oncology programs would presently be able to meet these requirements. We compiled a list of accredited radiation oncology residency programs from the ACGME website and then visited each program's webpage to count the number of radiation oncology residents and clinical physician faculty to calculate the corresponding ratio. We included clinical faculty from the main campus and selected satellite and affiliate sites if residents definitely or probably rotated there. We also searched the websites of each sponsoring institution for sponsored pathology, medical oncology, and surgical oncology programs. We identified 90 ACGME-accredited radiation oncology residency programs. At least 9 programs appear to currently have a ratio of clinical physician faculty to residents of less than 1.5:1, ranging between 0.85 and 1.38. In addition, 1 sponsoring institution does not have its own hematology and medical oncology or medical oncology program, 61 do not have a surgical oncology fellowship, and 5 do not have a pathology residency; however, this does not include affiliated programs. Approximately 10% of radiation oncology residency programs seem to have insufficient clinical faculty to accommodate their residents per the new ACGME requirements. Furthermore, almost 70% of sponsoring institutions do not sponsor a medical oncology, pathology, or surgical oncology program, though this does not include potentially affiliated programs. A primary limitation of our study is that we collected information from publicly available information, which may be inaccurate. Nevertheless, based on our findings, the new requirements may likely impose challenges on several programs, and failing to meet the requirements can risk program accreditation.

The Impact of Updated ACGME Program Requirements for Radiation Oncology Residencies

Background In 2022, the Accreditation Council for Graduate Medical Education (ACGME) made several changes to the common program requirements for radiation oncology, which may be difficult for some residency programs to meet in their current state. Now, programs are expected to have 1.5 clinical physician faculty members per resident. Plus, the sponsoring institution must sponsor at least one medical oncology program and sponsor or have affiliations with ACGME-accredited surgical oncology and pathology programs. We sought to investigate if radiation oncology programs would presently be able to meet these requirements. Methods We compiled a list of accredited radiation oncology residency programs from the ACGME website. We visited the webpage of each program to count the number of radiation oncology physician residents and clinical physician faculty to calculate the corresponding ratio. We included clinical faculty from main campus and select satellite sites and affiliate sites, if residents definitely or probably rotated there. We also searched the websites of each sponsoring institution for sponsored pathology, medical oncology, and surgical oncology programs. Results We identified 90 ACGME-accredited radiation oncology residency programs. At least 9 programs appear to currently have a ratio of clinical physician faculty to residents of less than 1.5:1, ranging from 0.85 to 1.38. Additionally, 1 sponsoring institution does not have its own hematology and medical oncology or medical oncology program, 61 do not have a surgical oncology fellowship, and 5 do not have a pathology residency; however, this does not include affiliated programs. Discussion Approximately 10% of radiation oncology residency programs seem to have an insufficient number of clinical faculty to accommodate their residents, per new ACGME requirements. Furthermore, almost 70% of sponsoring institutions do not sponsor a medical oncology, pathology, or surgical oncology program, though this does not include potentially affiliated programs. A primary limitation of our study is that we collected information from publicly available information, which may be inaccurate. Nevertheless, based on our findings, it is likely that the new requirements may impose challenges on several programs, and failing to achieve them can risk program accreditation. In 2022, the Accreditation Council for Graduate Medical Education (ACGME) made several changes to the common program requirements for radiation oncology, which may be difficult for some residency programs to meet in their current state. Now, programs are expected to have 1.5 clinical physician faculty members per resident. Plus, the sponsoring institution must sponsor at least one medical oncology program and sponsor or have affiliations with ACGME-accredited surgical oncology and pathology programs. We sought to investigate if radiation oncology programs would presently be able to meet these requirements. We compiled a list of accredited radiation oncology residency programs from the ACGME website. We visited the webpage of each program to count the number of radiation oncology physician residents and clinical physician faculty to calculate the corresponding ratio. We included clinical faculty from main campus and select satellite sites and affiliate sites, if residents definitely or probably rotated there. We also searched the websites of each sponsoring institution for sponsored pathology, medical oncology, and surgical oncology programs. We identified 90 ACGME-accredited radiation oncology residency programs. At least 9 programs appear to currently have a ratio of clinical physician faculty to residents of less than 1.5:1, ranging from 0.85 to 1.38. Additionally, 1 sponsoring institution does not have its own hematology and medical oncology or medical oncology program, 61 do not have a surgical oncology fellowship, and 5 do not have a pathology residency; however, this does not include affiliated programs. Approximately 10% of radiation oncology residency programs seem to have an insufficient number of clinical faculty to accommodate their residents, per new ACGME requirements. Furthermore, almost 70% of sponsoring institutions do not sponsor a medical oncology, pathology, or surgical oncology program, though this does not include potentially affiliated programs. A primary limitation of our study is that we collected information from publicly available information, which may be inaccurate. Nevertheless, based on our findings, it is likely that the new requirements may impose challenges on several programs, and failing to achieve them can risk program accreditation.

Emergency medicine resident involvement in emergency medical services

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience >50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.

589 Burn Center Trainees: Not Just for Surgery or Plastic Surgery Residents

IntroductionThe Burn unit offers a unique training environment for residents. The Accreditation Council for Graduate Medical Education (ACGME) requires all General Surgery trainees to have knowledge of burn physiology and experience with initial burn management. However, there are no burn requirements for other ACGME-sponsored training programs except for Plastic Surgery. Since care of the burned patient spans multiple settings – the intensive care unit, operating room, wards, outpatient clinic, and the emergency department – having residents from varied specialties might benefit not only the trainee, but also the Burn Center.MethodsA retrospective review of all residents rotated to the burn center of an American Burn Association verified unit was performed. Data from the 7/2018-6/2018 academic year were collected by analyzing resident rotational and call schedules of both intra institutional and inter-institutional residents. The specific time period was chosen to account for COVID affecting the number of residents more recently.ResultsA total of 48 residents rotated at the burn center during the studied academic year. Within the institution, there were 34 residents (71%): 12 general surgery interns (8 categorical, 4 preliminary), 2 plastic surgery interns, 10 emergency medicine (EM) residents, and 10 anesthesia residents. There were 14 residents (29%) from 3 outside institutions: 3 plastic surgery residents, 8 surgery interns from one program, and 3 surgery interns from another program. All surgical specialty trainees were interns, whereas other specialties, EM and anesthesia, were PGY2 trainees.ConclusionsWhile most residents were from general surgery and plastic surgery programs (58%) due to ACGME requirement, a significant portion of the resident complement (42%) was from non-surgical specialties. EM residents gain competency in wound reading as well as burn critical care. Anesthesia residents learn surgical management of the burn patient and critical care procedures. Since the burn center is a tertiary referral center, having outside residents rotating in the burn unit might facilitate transfers and increase knowledge of proper resuscitation.

Fine-needle aspiration performance during cytopathology fellowship: what do the ACGME case logs show us?

Cytopathology fellows are required to enter their fine-needle aspiration (FNA) case numbers in an online data collection system, the Accreditation Council for Graduate Medical Education (ACGME) Case Log system. This study reviewed this data to examine trends in FNA case numbers during fellowship training. A retrospective review of the ACGME Accreditation Data System (ADS) FNA Case Log data was performed for academic years 2006-2019. For 2006-2016, total and average numbers of FNAs performed per academic year were available. After 2016, data also included the number of programs and trainees, national averages, standard deviation, minimum, median, maximum, and percentiles for the number of FNAs performed. The number of FNAs documented by cytopathology fellows has gradually increased from 2006 (average 10.9) to 2013 (average 18.6) and dramatically increased in 2014 (average 38.0). Averages have remained greater than 30 FNAs documented per academic year since 2014, with some variation. However, a decline was observed in 2019, likely due to the COVID-19 pandemic. FNA procedures reported in the ACGME Case Log System indicate vast differences in cytopathology fellowship educational experiences and settings. After logging FNAs becoming an ACGME requirement in 2013, the average number of FNAs has been greater than 30 per year and provides some guidance for programs with respect to the number of FNAs being reported by cytopathology fellows nationally.

A Longitudinal Curriculum for Quality Improvement, Leadership Experience, and Scholarship in a Family Medicine Residency Program.

The Accreditation Council for Graduate Medical Education (ACGME) requires all residents be trained in quality improvement (QI), and that they produce scholarly projects. While not an ACGME requirement, residents need leadership skills to apply QI knowledge. We developed the Skills-based Experiential Embedded Quality Improvement (SEE-QI) curriculum to integrate training in QI, leadership, and scholarship. The University of Utah Family Medicine Residency Program began using the novel curriculum in 2012. The aim of the curriculum is to tie didactic teaching in quality improvement, leadership, and scholarship with skills application on multidisciplinary QI teams. Coaching for resident leaders is provided by faculty. Third-year resident leaders prepare academic presentations. Results of the ACGME Practice-Based Learning and Improvement (PBLI) 3 scores and number of scholarship presentations are described as a measure of efficacy. Two cohorts of residents completed the curriculum and all competency assessments. The average initial and final competency scores for competency PBLI-3 showed improvement and the average final competency for each cohort was above the proficient level. The residency requirements for QI scholarship did not change with introduction of the curriculum, but the amount of optional curricular QI scholarship and independent QI scholarship increased. The SEE-QI curriculum resulted in a high level of resident QI competency, opportunity for leadership training, and an increase in scholarship. We studied the results of this curriculum at one institution. Efforts to tie QI, leadership, and scholarship training should be evaluated at other programs.

A Needs Assessment of Palliative Care Education among the United States Adult Neurology Residency Programs.

Palliative care (PC) needs in patients with neurological diseases are becoming more recognized by neurologists and PC physicians. To qualify and quantify the PC education available in the United States adult neurology programs since the Accreditation Council for Graduate Medical Education (ACGME) published updated mandates in 2009. A 22-question survey was electronically distributed to each neurology residency program in the United States. All program directors (PDs) and assistant/associate program directors (APDs) of adult neurology programs. This study had a 35% survey response rate (49 programs). Of the participating programs, 20% offer no PC education to residents. Communication, prognostication, and withdrawing life-prolonging therapies were the domains identified as the most important for resident education; these were also the domains PDs/APDs were most comfortable providing for their own patients, and the domains their residents are the best trained in currently. Addressing spiritual distress was the domain considered the least important, the domain PDs/APDs were least comfortable providing for their own patients, and the domains residents are currently the least well-trained in. Forty-two percent of programs were dissatisfied with the PC education available at their program. Time for teaching, availability of faculty, and faculty expertise were the most common barriers. PC education varies greatly across the United States adult neurology residency programs despite ACGME requirements. As time and resources limit current training, utilization of interdisciplinary educational teams and nationally available PC educational material may improve implementation of PC education in these residency programs.

44 - A Quality Improvement Project to Improve Timeliness of Submission of Fellow Evaluations by Neonatology Faculty

Background: Evaluation of pediatric trainees by faculty is an important and required part of any training program. Timeliness is also imperative as it is an Accreditation Council for Graduate Medical Education (ACGME) requirement that at least 90% of evaluations are received on time. Our neonatal-perinatal fellowship program has a total of 12 fellows who are evaluated by 42 faculty members. We recognized that our fellowship training program was not compliant with ACGME requirements as the majority of the faculty evaluations of our neonatal fellows were being submitted late.

Creating a Geriatrics Curriculum in a Continuing Care Retirement Community.

The new Accreditation Council for Graduate Medical Education (ACGME) guidelines for family medicine residencies increased training requirements for caring for older adults. These guidelines prompted changes to the current geriatrics curriculum at the Trident/Medical University of South Carolina (MUSC) Family Medicine Residency Program. Changes to the training requirements and the residency geriatric experiences reflect an increasingly aging population and many unmet needs in caring for older adults. To meet accreditation requirements and the needs of our population, the residency program established a new partnership with a continuing care retirement community (CCRC) and hired another provider to coordinate the curriculum. Changes to the curriculum included more time spent in our CCRC, better longitudinal patient visit continuity, a coordinated interprofessional didactic curriculum, more elective opportunities in geriatrics, and online pharmacotherapy quizzes. The curriculum was assessed with a validated 10-question pre/postresident survey. Resident responses revealed increased comfort in caring for a geriatric population, increased desire to focus on geriatrics in their medical career, and increased participation in the geriatrics track. With changes in ACGME requirements, family medicine residency programs must develop a comprehensive curriculum to care for an increasing elderly population. The Trident/MUSC Family Medicine Residency provides a model curriculum for other programs seeking to improve training for their residents and meet these requirements.

National trends in otolaryngology intern curricula following Accreditation Council for Graduate Medical Education changes.

In 2016, Accreditation Council for Graduate Medical Education (ACGME) requirements for curriculum and resident experiences were modified to require entering postgraduate year (PGY)-1 residents to spend 6 months of structured education on otolaryngology-head and neck surgery (ORL-HNS) rotations. We aimed to determine how ORL-HNS training programs have adapted curricula in response to 2016 ACGME curriculum requirement changes. Survey study. A national survey of ACGME-accredited ORL-HNS programs was distributed via the Otolaryngology Program Directors Organization. Thirty-seven program directors responded (34.9%). Most common ORL-HNS rotations included general otolaryngology (80.6% of programs, up to 6 months) and head and neck oncology (67.7%, up to 4 months), though more months are also spent on other subspecialty rotations (laryngology, otology, rhinology, and pediatrics) than previously. All programs continue at least 1 month of anesthesiology, intensive care unit, and general surgery. Programs have preferentially eliminated rotations in emergency medicine (77% decrease) and additional months on general surgery (48% decrease). Curricula have incorporated supplemental teaching modalities including didactic lectures (96.3% of programs), simulation (66.7%), dissection courses (63.0%), and observed patient encounters (55.5%), to a greater degree following ACGME changes. More interns are involved in shared call responsibilities than in previous years (70.4% vs. 51.8%). A stable minority of interns take the Otolaryngology Training Examination (approximately 20%). New ACGME requirements have challenged ORL-HNS training programs to develop effective 6-month rotation schedules for PGY-1 residents. Significant variation exists between programs, and evaluation of first-year curricula and readiness for PGY-2 year is warranted. NA Laryngoscope, 1811-1816, 2018.

Developing the National Family Medicine Graduate Survey.

Developing the National Family Medicine Graduate Survey.

Forensic Psychiatry Milestones: Experience After 1Year.

In 1999, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties identified six core competencies for medical practice. In 2013, the milestones were introduced to demonstrate these educational outcomes across each specialty. This study represents the first examination of the sub-specialty Forensic Psychiatry Milestones. Members of the Association of Directors of Forensic Psychiatry Fellowships were surveyed. Areas of inquiry included whether milestones assisted in identifying areas of deficiency in fellows or programs, whether the graduation milestones matched the goals of training, and what changes were planned, or had been made, based on their implementation. Twenty-six of 35 programs responded, for a response rate of 74%. The majority found the milestones somewhat or very useful, half found the graduation-level milestones matched the program's graduation goals, and a significant majority reported that the milestones assisted in identifying improvements, change, or intended change. In choosing terms to describe the milestones, however respondents chose a variety of negative or neutral terms, rather than positive ones. The milestones provided a standard mechanism for identifying areas for improvement and a common language to standardize practice. However, due to the variability across fellowship programs and the limitations of educational resources and time, implementation of the new ACGME requirement was characterized in largely negative terms. Recommendations for improvement included modification of the milestones themselves, flexibility in their implementation, and evidentiary support for their use.

The Impact of Resident Duty Hour and Supervision Changes: A Review.

In 2003 and again in 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted increasingly stringent requirements governing resident hours and supervision, with the goals of improving patient safety, resident well-being, and resident education. Although the changes initially stemmed from a catastrophic outcome in a patient treated with psychotropic medications and behavioral restraints, and have been in place over a decade, many psychiatrists are not familiar with these changes and with their potential effects and "side effects" on today's trainees and faculty. The authors review the history leading to these changes, summarize the revised requirements, and review representative literature regarding the impact of the changes. The existing studies of the impact of the new requirements on improving patient safety, resident well-being, and resident education are inconclusive, and most editorials, perspectives, and surveys of faculty and residents reflect a lack of enthusiasm for the changes. They go on to suggest the need for evidence-based outcome studies prior to the institution of further major changes in ACGME requirements.

Pediatric Residency Program Handover: Before and After the ACGME Requirement

ObjectiveTo determine what changes occurred in pediatric residency programs with regards to handover education and assessment before and after the Accreditation Council for Graduate Medical Education (ACGME) requirement mandating monitoring safe handover practices in July 2011. MethodsWe sent surveys at 2 time periods to all pediatric program directors in the United States, as identified from a list provided by the Association of Pediatric Program Directors. Respondents were asked about their program demographics, whether they had handover curricula, how trainees were taught to perform handovers, and perceived barriers to effective handover. ResultsResponse rates were 58% in both survey years. After the ACGME requirement, only 1 of 3 of programs reported a handover curriculum with goals, objectives, and assessment tools. There was a statistically significant increase in the percentage of those responding that resident handover education primarily occurred by role modeling (66% vs 82%; P < .05). Other learners (visiting residents, medical students) also continued to learn handover skills by role modeling (55% vs 56%; P = NS). Lack of feedback and interruptions were recognized as barriers to successful handover by program directors in both survey years. ConclusionsThere is a continued need for handover curricula with didactic and practical components as well as assessment pieces within pediatric residency programs. Barriers to effective handover such as lack of feedback and interruptions continue to be major problems. There is a lack of faculty ownership and interest in learner handover that may affect long-term successes. Because role modeling continues to be the main way in which trainees learn handover, specific attention should be given to teach role-modeling techniques.

Developments and innovations in resident and fellowship education: review article.

Medical trainee education has drastically changed over the past 30years significantly since the inception of the Accreditation Council for Graduate Medical Education (ACGME) in 1981. With an emphasis on patient safety, regulations and oversight from the ACGME have drastically changed the way many programs function with respect to trainee responsibilities, duty hours, and resident supervision. The purpose of this review is to summarize significant changes and innovations implemented by the ACGME and their proposed effects on trainee education. While there is an emphasis on musculoskeletal radiology fellowship training, the majority of the regulations and guidelines are applicable to all training programs. Articles, commentaries, and policies focusing on ACGME requirements were reviewed, with a focus on musculoskeletal radiology. Changes in ACGME policies have resulted in significant structural modifications in how training programs are designed, specifically with respect to curriculum standardization, measuring outcomes of trainee performance, and integration of residents and fellows into hospital-based quality improvement and patient safety initiatives. With an eye to continued training program advancement and improvement, the goal of universal oversight and standardization in medical training remains to produce forward-thinking physicians with an emphasis on lifelong learning, patient care, and quality improvement.

Residency training in handoffs: a survey of program directors in psychiatry.

The purpose of this study was to investigate how psychiatry programs are addressing the new Accreditation Council for Graduate Medical Education (ACGME) training requirements regarding transitions in patient care effective July 1, 2011. An anonymous online survey was distributed to program directors of general psychiatry residencies within the USA. Survey questions pertaining to the 2011 ACGME handoff requirements focused on training modalities, assessment of competence, and oversight of appropriate handoff procedures. In addition, program directors were asked to share specific challenges in implementing the new handoff regulations as well as their view on how the new regulations would impact patient care. Of the 177 recipients, 108 completed at least part of the survey (61 % response rate). Only 11.4 % of programs indicated that they did not need to make any changes to their program in order to meet the new guidelines. Approximately a third of survey respondents reported that they did not yet have a formal curriculum in handoffs (32.4 %) and/or did not specifically assess competence at handoffs (30.5 %). Program directors cited the challenge of working with a variety of clinical settings with unique cultures, infrastructure, and policies and procedures and suggested that implementation and ownership of handoff training and assessment should be at the level of the clinical services. Despite these challenges, most program directors agreed that the new ACGME requirements would improve patient care and safety. The high frequency of programs without established handoff curricula or competence evaluations highlights the potential value of published resources and tools to provide standardized training and assessment in handoffs. The results also underscore the importance of developing training and assessment in close collaboration with the clinical services and recognizing the need to tailor handoff communications to address the types of transitions that occur within each clinical setting.