Accreditation Council For Graduate Medical Education Guidelines Research Articles

A Dedicated Research Rotation Increases Orthopaedic Residency Scholarly Activity.

Although clinical research has traditionally been a part of orthopaedic residency, there are now certain core requirements created by the Accreditation Council for Graduate Medical Education (ACGME), which outline the type of research activities to be completed during residency. However, there are no specific details included in the ACGME guidelines regarding how these milestones are to be met. Nor is there specificity regarding expectations of scholarly activity to be completed by the time of graduation. There is a paucity of literature demonstrating the effectiveness of implementing a dedicated research block in an orthopaedic surgical residency, especially in the community setting where limited research-related resources are available. We implemented a dedicated research rotation along with a set of research milestones and guidelines at our single orthopaedic surgery community residency program. A search was performed through PubMed using residents' and faculty members' names to find publications included a 7-year period from 2015 to 2022 to determine number of publications by residents and faculty. Scholarly activity of faculty was analyzed and quantified using self-reported annual surveys. The average annual number of resident publications (by all 25 residents) increased from 2 to 26 after implementation of a dedicated research rotation. Faculty's scholarly activity, as measured by the following criteria, increased as well: number of publications (from 22 to 55), conference presentations (from 51 to 83), and other presentations (from 43 to 72). Implementation of a dedicated research rotation in a community orthopaedic residency program is associated with an increased publication rate in major academic journals among residents and faculty. There is also an observed association with implementation of a dedicated resident research rotation and an increase in faculty scholarly activity satisfying ACGME faculty requirements.

Incoming International Medical Graduates and the COVID-19 Pandemic: More Than Meets the Eye.

Incoming International Medical Graduates and the COVID-19 Pandemic: More Than Meets the Eye.

A Pilot Study on Diagnostic Radiology Residency Case Volumes From a Canadian Perspective: A Marker of Resident Knowledge.

New guidelines from the Accreditation Council for Graduate Medical Education (ACGME) have proposed minimum case volumes to be obtained during residency. While radiology residency programs in Canada are accredited by the Royal College of Physicians and Surgeons of Canada, there are currently no minimum case volumes standards for radiology residency training in Canada. New changes in residency training throughout Canada are coming in the form of competency-based medical education. Using data from a pilot study, this article examines radiology resident case volumes among recently graduated cohorts of residents and determines whether there is a correlation between case volumes and measures of resident success. Resident case volumes for 3 cohorts of graduated residents (2016-2018) were extracted from the institutional database. Achievement of minimum case volumes based on the ACGME guidelines was performed for each resident. Pearson correlation analysis (n = 9) was performed to examine the relationships between resident case volumes and markers of resident success including residents' relative knowledge ranking and their American College of Radiology (ACR) in-training exam scores. A statistically significant, positive correlation was observed between residents' case volume and their relative knowledge ranking (r = 0.682, P < .05). Residents' relative knowledge ranking was also statistically significant and positively correlated with their ACR in-training percentile score (r = 0.715, P < .05). This study suggests that residents who interpret more cases are more likely to demonstrate higher knowledge, thereby highlighting the utility of case volumes as a prognostic marker of resident success. As well, the results underscore the potential use of ACGME minimum case volumes as a prognostic marker. These findings can inform future curriculum planning and development in radiology residency training programs.

Brief (

The Accreditation Council for Graduate Medical Education (ACGME) recently reinstated extended-duration (24-28 hr) work shifts (EDWS) for postgraduate year 1 (PGY-1) resident physicians. This study examined the relationship between overnight sleep duration during EDWS and subsequent "post-call" performance in PGY-1 resident physicians. Thirty-four PGY-1 resident physicians (23 males; 24-32 years) were studied between 2002 and 2004 during 3-week Q3 "on-call" rotation schedules in the Medical and Cardiac Intensive Care Units at Brigham and Women's Hospital in Boston. Daily sleep logs (validated by ambulatory polysomnography) were collected and the 10 min psychomotor vigilance task (PVT) was administered every ~6 hr during each EDWS. Generalized estimating equations were used to examine the relationship between overnight sleep duration and PVT performance "post-call" (0500-1900 hr). Postcall performance during EDWS was compared with sessions matched for time-of-day and weeks-into-schedule in the same resident physician during an intervention schedule that eliminated EDWS. Resident physicians obtained an average of 1.6 ± 1.5 hr cumulative sleep overnight during EDWS (<4 hr on 92% of nights). PVT attentional failures were significantly reduced only after >4 hr sleep (p = 0.027 versus no sleep). Despite this apparent improvement, the odds of incurring >1 attentional failure were 2.72 times higher during postcall following >4 hr sleep compared with matched sessions during non-EDWS. Even with >4 hr sleep overnight (8% of EDWS), performance remained significantly impaired. These findings suggest that even "strategic napping," a recommendation recently removed from ACGME guidelines, is insufficient to mitigate severe performance impairment introduced by extending duty beyond 16 hr.

Fellowship Training in Pediatric Pathology: A Guide for Program Directors

ABSTRACT The Accreditation Council for Graduate Medical Education (ACGME) has provided guidance for specialty and subspecialty fellowship training programs by defining 6 core competencies that must be met. Furthermore, the ACGME has defined several program requirements for pathology training, including those applicable to several pathology subspecialties. However, the requirements are broad and lack specific details, particularly as they pertain to the unique nature of pediatric pathology. The Fellowship Committee of the Society for Pediatric Pathology examined the ACGME requirements and interpreted the guidelines with respect to their application to training in pediatric pathology. The Committee worked within the ACGME guidelines to provide an expanded and more comprehensive set of guidelines for use by pediatric pathology fellowship directors and trainees. The resultant document lists the educational goals, core competencies, and program requirements with specific application to pediatric pathology. In addition, methods for assessing and documenting the progress of the individual trainees as they progress through each requirement are provided. It is to be emphasized that many of the guidelines set forthwith are flexible, and allowances should be made for individual differences of each training program.

The revised ACGME laparoscopic operative requirements: how have they impacted resident education?

Laparoscopic surgery has been an essential component of surgical education for the last two decades. The Accreditation Council for Graduate Medical Education (ACGME) changed the requirements for laparoscopic cases beginning with graduates in 2008, and the Fundamentals of Laparoscopic Surgery program was introduced over a decade ago as a method of measuring competency with laparoscopic techniques. The purpose of this study was to determine what changes have been made to meet these requirements and how these changes have impacted general surgery residents in their preparation to perform both basic and complex laparoscopic procedures upon completion of residency. A 23-question survey was distributed electronically to all fourth- and fifth-year residents of United States general surgery residency programs. Respondents were queried about demographics, perception of surgical education, and their level of preparedness to perform laparoscopic cases upon graduation. The survey was completed by a total of 321 residents (174 fourth-year and 147 fifth-year). Nineteen percent of respondents indicated that they anticipated problems meeting the new ACGME guidelines and 18.7% of all respondents indicated that changes had been made to their program to meet those new requirements. The majority of residents felt they had adequate laparoscopic training upon graduation, but there was a disparity between program types. Despite this finding, more than one-third of respondents believed that it would be necessary to seek additional laparoscopic training post-residency graduation. Residency training programs have had to keep pace with evolving technology while preparing future surgeons to perform with confidence upon completion of residency training. The majority of residents feel their training has been adequate, but there are also a great number who believe they will need to continue their education in laparoscopic surgery to keep pace with this ever-evolving field.

Duty hours for pharmacy residents

Pharmacy residency programs are subject to the duty-hour standards of the Accreditation Council for Graduate Medical Education (ACGME), and those standards have been revised for 2011.1,2 However, the ASHP Commission on Credentialing (COC) will issue pharmacy residency programs a waiver from the 2011 ACGME standards until July 2013, and the COC will develop standards for pharmacy-specific duty hours to be implemented by July 2013. Until that time, pharmacy residency programs will remain accountable to the current 2007 ACGME duty-hour standards. We applaud the COC for its decision to allow programs to follow current standards in the interim. Evidence of the effects of sleep deprivation and fatigue on medical errors and performance led to more humanistic policies on the maximum weekly duty hours for medical residents and mandatory time for those residents to be free of duty. We agree that the environment should support learning and safe practice and that measures should be taken to attenuate the effects of sleep deprivation and fatigue, and we design our pharmacy residency programs to comply with ACGME guidelines.3 However, pharmacy training programs are only included in the general context of other residency programs within the ACGME guidelines. We maintain that pharmacy residents cannot be summarily included with other medical specialties when considering implementation of these standards, particularly within the context of training.

New Duty-Hour Rules Present Challenges

New Duty-Hour Rules Present Challenges

Impact of the 80-Hour Work Week on Mortality and Morbidity in Trauma Patients: An Analysis of the National Trauma Data Bank

The implementation of the 80-h work week restrictions implemented by the Accreditation Council for Graduate Medical Education (ACGME) in July 2003 were intended, in part, to improve patient outcomes by reducing fatigue-related resident errors. Although concerns were raised regarding the possibility for increased error due to decreased continuity of patient care, recent studies have shown no significant change in mortality or complication rates since the onset of these new restrictions. This study is the first to examine the effects of the 80-h work week on mortality in trauma patients on a national level. Data were obtained from the National Trauma Data Bank (NTDB) version 6.2 from 1994 to 2005. Data were then divided into two groups: "pre-80-h work week" (2001-2002) and "post-80-h work week" (2004-2005). Because the ACGME's guidelines were implemented mid-year in 2003, and because the NTDB classifies admission date only by year, all patients admitted during 2003 were excluded from the analysis. Information regarding patient demographics and hospital type (teaching versus nonteaching) was collected. Our primary outcome measure was mortality. Secondary outcomes included length of mechanical ventilation, length of ICU stay, and length of hospitalization. The overall mortality rate decreased from 4.64% in the pre-80-h work week to 4.46% in the post-80-h work week (P < 0.0001). Of particular interest were the differences in outcomes observed in academic versus nonacademic institutions. In university hospitals, the mortality decreased from 5.16% to 5.03% (P = 0.03), whereas in nonteaching hospitals, mortality increased from 3.37% to 3.85% (P < 0.001). There were also small but statistically significant improvements seen in secondary outcomes during the post-80-h work week. Despite the great deal of controversy surrounding the 80-h work week, few papers exist that specifically examine patient mortality within the field of trauma surgery. This large retrospective analysis demonstrates slightly decreased mortality and morbidity among trauma patients in university hospitals nationwide after implementation of the 80-h work week, even when controlling for possible confounders. Although these differences are not likely to be clinically important, the data are statistically very significant. Therefore, we conclude that the 80-h work week has not resulted in any significant deterioration in patient outcomes in this particular population.

Pediatric surgery fellowship compliance to the 80-hour work week

Objective The goal of this study was to determine the compliance of pediatric surgery fellowships with Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions while confronting a reduced resident workforce. Materials and Methods An evaluation of training programs was performed by surveying pediatric surgery fellows on aspects of work hours, ACGME guideline compliance, operative case volume, employment of physician extenders, and didactic education. Results A 74% survey response rate was achieved. Of the respondents, 95% felt fully aware of ACGME guidelines. Although 95% of programs had mechanisms for compliance in place, only 45% of fellows felt compliant. Median work hours were 80 to 90 hours per week. Although subordinate residents were felt to obtain better compliance (>86%), only 69% of fellows perceived greater service commitment as a result. No impact on volume of operative cases was perceived. Of the programs, 89% employed physician extenders and 55% used additional fellows, but no overall effect on fellow work hours was evident. Fellows did not identify an improvement in the quality of clinical fellowships with guideline implementation. Conclusions A minority of fellows comply with ACGME guidelines. Vigilance of duty hour tracking correlates to better compliance. A shift of patient care to fellows is perceived. Use of support personnel did not significantly aid compliance.

Resident Duty Hours Reform: Results of a National Survey of the Program Directors and Residents in Neurosurgery Training Programs

The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. The response rates were 45% and 23% among the program directors and residents, respectively. Most programs offered one (37%) or two (38%) resident training positions per year. Although 92% of programs had implemented the ACGME work hours requirements before or since July 2003, 8% had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84% (95% confidence interval [CI], 64-94%) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95% CI, 89-96%) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95% CI, 46-63%) of the residents and only 33% (95% CI, 20-50%) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95% CI, 22-37%) of the residents and 17% (95% CI, 8-32%) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46% (95% CI, 37-54%) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21% (95% CI, 11-37%) of program directors agreed. Forty-one percent (95% CI, 33-49%) of the residents and 74% (95% CI, 58-86%) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61% (95% CI, 53-69%) of the residents and 79% (95% CI, 63-89%) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.

Effect of resident work hour restriction on surgical outcome

Background. Resident duty hour limitations adopted by the Accreditation Council for Graduate Medical Education (ACGME) were triggered by concerns regarding the effect of resident fatigue and sleep deprivation on patient care and safety. The actual impact of restricting surgical resident duty hours on patient quality of care is unknown. Methods. The divisions of General and Vascular Surgery at the Michael E. DeBakey Houston VAMC implemented a limited work hours schedule effective October 1, 2002. We compared the rate of postoperative morbidity and mortality before and after implementing the new schedule. The data were collected, analyzed, and validated by the VA National Surgical Quality Improvement Program (NSQIP) for the periods of October 1, 2001 to September 30th, 2002 (preintervention), and October 1, 2002 to September 30, 2003 (postintervention). Observed/expected (O/E) ratios of mortality and morbidity were extracted and compared. The level of resident supervision in the operating room was determined for each case. Results. In the preintervention period, 405 cases were analyzed in General Surgery and 202 cases in Vascular Surgery as compared to 382 cases in General Surgery and 208 cases in Vascular Surgery in the postintervention period. O/E ratios of mortality were similar in the pre- and postintervention periods (0.63 and 0.60 in General Surgery; 0.78 and 0.81 in Vascular Surgery; P = 0.90 and 0.94, respectively). O/E ratios of morbidity were also similar in the pre- and postintervention periods (1.06 and 1.27 in General Surgery; 1.47 and 1.50 in Vascular Surgery; P = 0.20 and 0.90, respectively). Although a tendency toward more attending supervision in the operating room was noticed after the implementation of the new ACGME guidelines, this tendency was not found to be statistically significant. Conclusion. The restricted duty hour schedule did not affect postoperative outcome on the General and Vascular Surgery services in our facility.

Resident Stress Revisited: A Senior Pediatric Resident’s Point of View

It has been 15 years since Dr Abraham Bergman1 wrote his poignant essay for Pediatrics on resident stress. In some ways, it seems little has changed in those 15 years in the area of resident stress. Many of the points raised in Dr Bergman’s article are still relevant today. However, pediatric residents have recently entered a new era in pediatric education and training led by the Accreditation Council for Graduate Medical Education (ACGME).2 The ACGME has established guidelines that limit the number of hours a pediatric resident can work per shift, as well as per week. The guidelines set new standards for “competencies” in which residents should be trained as well as new ways that administrators must track and evaluate residents’ progress. The ACGME expects full compliance with these guidelines beginning July 1, 2003. As residents look forward with anticipation and hope to what changes these new guidelines will bring, it seems an appropriate time to revisit Dr Bergman’s article and evaluate the past and current sources of resident stress. This commentary will consider which sources of stress described by Dr Bergman are still relevant today, and whether the advent of the ACGME guidelines will alleviate any of these stressors for tomorrow’s pediatric house officer. Global causes of resident stress, as Dr Bergman explains, include the developmental milestones that pediatric residents must face as adults learning to balance their personal and professional lives. Dr Bergman lists the development of autonomy, individuation from one’s parents, and wrestling with financial independence as global causes of resident stress. These stressors are much the same today, as every new physician must struggle with his/her new role and new identity of being a physician. The development of financial independence continues to be a large source of stress for today’s debt-laden residents. The Future … Address correspondence to Megan A. Moreno, MD, University of Wisconsin-Madison, 3009 Stevens St, Madison, WI 53705. E-mail: ma.moreno{at}hosp.wisc.edu