1 Common Program Requirements Frequently Asked Questions ACGME Question Answer Institutions PLAs provide details on faculty, supervision, evaluation, educational content, length of What is the purpose of Program Letters of Agreement (PLAs)? assignment, and policy and procedures for each required assignment that occurs outside of an accredited program’s sponsoring institution. These documents are intended to protect the [Common Program Requirement : program’s residents/fellows by ensuring an appropriate educational experience under ; One I.B.1. -Year Common Program adequate supervision. PLAs are intended to be brief, informal documents (approximately ] Requirement: I.B.1. one- to-two pages in length) that as simply as possible: a) identify the faculty members who will assume both educational and supervisory responsibilities for residents/fellows; b) specify these faculty members’ responsibilities for the teaching, supervision, and formal evaluation of residents/fellows; c) specify the duration and content of the educational experience; and, d) state the policies and procedures that will govern resident/fellow education during the assignment. here A sample PLA can be found . /fellows There must be PLAs between an accredited program and all sites to which residents What is the minimum experience for rotate for required education or assignments. which a PLA needs to exist between an accredited program and a site involved in residency/fellowship education? : [Common Program Requirement ; One am I.B.1. -Year Common Progr : I.B.1.] Requiremen t Updated 08/2017 Common Program Requirements FAQs Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 1 of 28

2 Answer Question These types of courses are not examples of participating sites, and therefore do not require Are PLAs necessary for “courses,” PLAs. such as the Armed Forces Institute of Bellevue Pathology course or the Hospital Toxicology Course? : [Common Program Requirement I.B.1. ; One -Year Common Program Requirement: I.B.1. ] u niver A program sponsored by a sity Are PLAs needed when sites are h ospital that requires a rotation/assignment at the children’s clos ely associated? For instance, hospital would require a PLA if the two entities are operated by two different would PLAs be necessary between a governing bodies (e.g., two separate Boards of Directors). However, if the two sites operate hospital and the children’s university essentially as one entity, that is, they are governed by one governing body (e.g., a single hospital with which it has close ties? -associated Board of Directors), a PLA is not necessary. This reasoning applies to all closely niversity and children’s hospitals. sites, not only those between u [Common Program Requirement : I.B.1. ; One -Year Common Program red for a rotation to an integrated site if the written document between the A PLA is not requi ] Requirement: I.B.1. sponsor and the integrated site incorporates the elements of the PLAs (Common Program -d)). Including all the required elements in the Integration Agreement Requirements I.B.1.a) ill eliminate the need for a separate PLA. w PLAs are not necessary if the following on - campus site is under the governance of or off - Are PLAs necessary for rotations to physicians’ offices, nursing homes, the program’s S ponsoring Institution or is an office of a physician who is a member of that living homes; ambulatory surgical centers, and other nursing and assisted Institution’s teaching faculty/medical staff: Sponsoring similar learning environments? hospice facilities; faculty patient care offices; private physicians’ offices (volunteer faculty); , imaging, laboratory, etc.); treatment ambulatory surgical centers; diagnostic centers (e.g. , dialysis, rehabilitation, chemotherapy, etc.); or other similar sites. centers (e.g. : [Common Program Requirement I.B.1. ; One -Year Common Program Requirem ent: I.B.1. ] PLAs are required for rotations to these types of sites if not governed by the program’s Institution or if they occur in offices of physicians who are not members of the Sponsoring I Sponsoring nstitution’s teaching faculty/medical staff. Some Review Committees have more stringent criteria, so program directors should consult and review the specialty/subspecialty c Program R specialty section of the ACGME website for more specifi equirements and the details, when applicable. Updated 08/2017 Common Program Requirements FAQs 28 2 of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME)

3 Answer Question If a program director and/or faculty PLAs are not necessary when a rotation/assignment occurs at a site under the governance e program’s sponsor or in an office of a physician who is a member of the S member functions within multiple of th ponsoring participating sites that educate Institution’s teaching faculty/medical staff. However, in this example, the VA is unlikely to be residents/fellows (e.g., the program under the governance of the sponsor, so the program director needs to appoint a local -to-day activities of residents/fellows director at the VA site who is accountable for the day director oversees the program at the (Common Program Requirement II.A.4.b)). A PLA between the program director and the sponsoring university hospital and is local director would be necessary in this example. also the loc al director at the VA medical center), does he/she need a PLA with him/herself? : [Common Program Requirement -Year Common Program ; One I.B.1. ] Requirement: I.B.1. the PLAs for the A PLA should include the signatures of the program director as initiating the letter and the Who should sign and Institution Sponsoring director at the participating site. The official signing for the participating site to which local for the the residents/fellows rotate should be the individual responsible for supervising and participating sites? or or, in some overseeing resident/fellow education at that location (e.g., the local direct cases, the medical director). Although the Requirements do not specify that the PLA include : [Common Program Requirement the signature of the designated institutional official (DIO), institutions may find it prudent to I.B.1. ; One -Year Common Program the DIO, in collaboration with the Graduate include this signature. It is the responsibility of ] Requirement : I.B.1. ponsoring Institution, to establish and Medical Education Committee (GMEC) of the S administer the local policies and procedures regarding PLAs. Does a subspecialty program need a Although a single PLA that provides the Review Committee with appropriate information (i.e., the conten t of the experience, supervision, evaluation, length of assignment, policies separate PLA if the specialty ( core) and procedures) for both the specialty and subspecialty programs would be acceptable, program already has one in place with such a document may be long and overly complicated. The preferred strategy would be to a particular institution? develo p two separate letters, one for the specialty program, and another for the subspecialty program. : [Common Program Requirement ; One -Year Common Program I.B.1. Requirement : I.B.1. ] Common Program Requirements FAQs Updated 08/2017 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 3 of 28

4 Question Answer program director or in Agreements should be updated whenever there are changes When should PLAs be updated? participating site director or in resident/fellow assignments, or when there are revisions to -d). PLAs must be renewed the items specified in Common Program Requirements I.B.1.a) : [Common Program Requirement I.B.1. at least every five years. If nothing in the agreement has changed at the end of five years, it -Year Common Program ; One : I.B.1. Requirement is acceptable to add an amendment signifying review and extension of the agreement with ] signatures. How are PLAs reviewed for purposes During a program site visit, a program director should have the PLAs available for review by of accreditation? cutive the site visitor. Program directors and DIOs should contact the Review Committee Exe Director for more specific details or further clarification. : mmon Program Requirement [Co -Year Common Program ; One I.B.1. has linked on the first page of this document The sample been prepared to template PLA Requirement ] : I.B.1. assist DIOs and program directors. It represent s the minimal detail acceptable to a Review Committee . Addition of more detail is not required and occurs at the sole discretion of the I S ponsoring nstitution or participating site according to local policies and procedures. No; the Institutional Requirements (effective since 7/1/14, including the most recent revision, nstitution required to I ponsoring Is a S effective 7/1/15) no longer require S ponsoring Institutions to maintain master affiliation maintain master affiliation agreements agreements with their major participating sites. its major participating sites? with : [Common Program Requirement -Year Common Program I.B.1. ; One ] : I.B.1. Requirement Resident/ Fellow Appointments III.A. apply to prerequisite training for entry or 2016 in section eligibility requirements eligibility The In what settings are the 2016 requirements applicable? -2 level -accredited residency programs. This includes entry at the PGY transfer into ACGME (or above) into progra ms in specialties that require an initial year (or two) prior to entry into a [Common Program Requirement s: program (e.g., anesthesiology, diagnostic radiology, neurology, nuclear medicine, etc.), and Common III.A. – III.A. 2.c) -Year ; One require transfer entry at the PGY -2 level (or above) into programs in specialties that do not – Program Requirement s: III.A. an initial year prior to entry into a program (e.g., internal medicine, pediatrics). The new ] III.A.3. requirements are effective July 1, 2016 (i.e., for entry into residency during Academic Year 2017). 2016- e-Year Common Program Requirement III.A.) (On Eligibility requirements III.A. and III.A.2. also apply to prerequisite training for entry into ACGME -accredited fellowship programs. They are effective July 1, 2016 (i.e., for entry into fellowship during Academic Year 2016 - Updated 08/2017 Common Program Requirements FAQs 28 4 of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME)

5 Answer Question 2017). For initial entry into ACG ME -accredited residency programs that require no prerequisite graduate medical education, the eligibility requirements remain unchanged. See Institutional Requirements S ection II.A.1. The ed eligibility requirements address 2016 Why did the ACGME adopt the 2016 a heterogeneity of previous ACGME program -2 level or requirements related to the eligibility of trainees to enter programs at the PGY eligibility requirements? beyond, and to the eligibility for entry into fellowship programs. A more uniform requirement is appropriate to define the ACGME accreditation credential, upon which Medicare, state Program Requirements: [Common physician licensing boards, medical certifying boards, and hospital credentials committees -Year Common – III.A.2.c); One III.A. rely in the assessment of the trainee’s performance of the GME program. Program Requirement – s: III.A. III.A.3.] - developed ACGME accredited residency and fellowship programs operate with a well What did the ACGME consider - educational curriculum; qualified faculty; supervision and graduated responsibility; ongoing important in adopting the 2016 eligibility requirements for entry into ponsoring Institution evaluation of trainee competence; and required program director and S ACGME -accredited residency and oversight. Collectively, these attributes allow trainees to safely and effectively participate in fellowship programs? patient care. [Common Program Requirements: Furthermore, the physician and other health care colleagues of each resident/fellow make – III.A.2.c); One III.A. -Year Common assumptions concerning the resident’s/fellow’ s previous experience, and have reasonable Program Requirement – s: III.A. expectations of the competence of the individual. Therefore, the ACGME has the III.A.3.] responsibility to maintain accreditation requirements that require that prerequisite training will meet those assumptions and expectat ions. The implications for fellowship entrants are even more significant because of their engagement in clinical care with reduced supervision, and their role as teachers and supervisors for more junior residents. All members of the health care team have expectations of prior levels of education and demonstrated competence of these advanced trainees. The central theme of the ACGME’s Next Accreditation System (NAS) is revision is the tracking of resident/fellow performance and competence continually throughout training, documenting each resident ’s/fellow’s development and performance in areas deemed essential by the profession. This tracking will periodically inform the resident/fellow, as well ndependent practice. NAS as the public, of satisfactory progress of each trainee toward i tracking will document improvement where residents/fellows have previously failed to achieve expectations in relationship to ilestones of development in each of the six m Updated 08/2017 Common Program Requirements FAQs 28 5 of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME)

6 Answer Question ones. Through the NAS, the specialty - specific domains of clinical competency, the Milest ACGME continually monitor s the effectiveness of the educational environment. This developmentally founded, national standard- based tracking of resident/fellow idents/fellows development provides the essential structure for the formation of res participating in ACGME programs. -accredited residency /fellowship Residents/fellows who train in environments other than ACGME -accredited programs lack any ACGME accreditation oversight of the educational program. More importantly, these inees are not evaluated using the ACGME schema, and the results of that evaluation are tra not tracked by the ACGME. Thus, subject to the exceptions in the new requirements, the ACGME cannot ensure the public of the quality of the required preparation for entr y into advanced training positions in ACGME - accredited programs. - accredited residency or fellowship does not ensure Eligibility for appointment to an ACGME Will residents/fellows who are eligible for appointment to ACGME -accredited eligibility for board certification. Programs are responsible for advising residents/fellows to contact the applicable ABMS boards regarding eligibility for certification. programs under the 2016 ACGME eligibility requirements also be eligible for certification by the applicable Americ an Board of Medical Specialties (ABMS) boards? [Common Program Requirements: III.A. – III.A.2.c); One -Year Common s: III.A. – Program Requirement III.A.3.] accredited” - Does training in a “dually Training in a program that is “dually accredited” by the ACGME and the American Osteopathic Association ( AOA) is regarded the same as that in any other ACGM E- program fulfill eligibility requirements? accredited program. Such training fulfills the eligibility requirements for entry into residency programs requiring one (or more) years of prerequisite training. Core residency training Program Requirements: [Common fulfills requirements for transfer to another ACGME -accredited progr am in the same III.A. -Year Common – III.A.2.c); One specialty. Completion of a residency program fulfills eligibility requirements for a fellowship – s: III.A. Program Requirement in that same specialty. (Note that while the AOA refers to these as “dually -accredited III.A.3.] y are not entirely the same). programs,” the resident complements, curricula, and facult Updated 08/2017 Common Program Requirements FAQs 28 6 of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME)

7 Question Answer Why does the ACGME accept Royal - RCPSC During the past 25 years, most ACGME specialty requirements have accepted -accredited programs. RCPSC - College of Physicians and Surgeons accredited training as prerequisite for entry into ACGME -based training paradigm (CanMEDS) accredited residency programs utilize a competency -accredited and of Canada (RCPSC) that is very similar to ACGME Milestones. RCPSC -accredited programs are based in College of Family Physicians of the Canada (CFPC) -accredited training in specialty departments of Canadian medical schools accredited jointly by the RCPSC and the Liaison Committee on Medical Education (LCME), the group that accredits allopathic Canada? medical schools in the United States. s: [Common Program Requirement .1.b), and III.A.2.; One - III.A.1.a), III.A idency programs accredited by the CFPC Like RCPSC- accredited residency programs, res Year Common Program Requirement: utilize CanMEDS and are based in specialty departments of Canadian medical schools III.A.] accredited jointly by the RCPSC and LCME. In addition, the same general standards for the ams that are utilized by the RCPSC are also accreditation of postgraduate training progr utilized by the CFPC. For entry into ACGME - In specialties that do not require an initial year prior to entry into a program, a credit for one accredited s in specialties that s discretion, for residents who have year of training may be allowed, at the program director’ residency program completed a residency program in the specialty not accredited by the ACGME, RCPSC, or do not require an initial year prior to entry into a program, can trainees CFPC. Such residents must enter at the PGY -1 level and may be advanced to the PGY -2 receive any credit for training level by the Clinical Competency Committee based on Milestone assessments. n programs not accredited completed i /CFPC? by the ACGME or the RCPSC s do not review or approve this credit for prior training on a per The Review Committee - resident resident basis. The appropriate ABMS board should be contacted to determine if a will receive credit for prior training. : [Common Program Requirement III.A.1.b)] To w is completion of an international residency . hat training does “...a residency An e xample of training referenced in III.A.1.b) who have completed such training are eligible for admission to an ACGME program that was not accredited by Individuals - the ACGME, RCPSC, or CFPC...” -2 level based on -1 level and advancement to the PGY accredited program at the PGY Milestones assessments. Note that this applies only to programs in specialties for which an refer? linical year is not required for entry. initial c : [Common Program Requirement III.A.1.b)] Updated 08/2017 Common Program Requirements FAQs Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 7 of 28

8 Question Answer Review Committees may grant the exception specified in III.A.2.b) of the Program Will residents who have completed Requirements for residency programs in specialties that require completion of another residency programs not accredited by prerequisit e residency program prior to admission. Note that this applies only to programs in the ACGME, RCPSC, or CFPC be eligible for appointment to an ACGME specialties for which an initial clinical year is not required for entry. - accredited residency program that requires completion of a residency as The Review Committees for Allergy and Immunology and Nuclear Medicine may grant the a prer equisite for entry? ified in III.A.2.b) of the Program Requirements for residency programs that exception spec require completion of another prerequisite residency program prior to admission. [Common Program Requirement s: The Review Committees for Colon and Rectal Surgery, Plastic Surgery, and Thoracic III.A.1.c) and III.A.2.b)] Surgery will not permit this exception. -graduate year) after Nuclear medicine programs accept residents at the NM1 (second post completion of a clinical base year, at the NM2 level after completion of a residency program ompletion of a radiology residency. in another specialty, and at the NM3 level after c Applicants entering at the NM1 level would need to complete a clinical base year accredited - -ACGME by the ACGME, RCPSC, or CFPC. Applicants who have completed a non ic radiology could apply for entry at residency in another specialty or in diagnost accredited the NM2 or NM3 level respectively per III.A.2.b). Updated 08/2017 Common Program Requirements FAQs 28 8 of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME)

9 Question Answer a a s ystem, an individual who completes a s ccreditation ingle GME The 2016 eligibility requirements During the transition to has achieved ACGME Initial Accreditation is eligible for appointment to an program after it specify that all required clinical ACGME education for entry into ACGME -accredited fellowship presuming that the core residency program completed by the - e individual is in a specialty that is an acceptable prerequisite as specified in the applicabl accredited fellowship programs must subspecialty Requirements. Program be completed in an ACGME - accredited residency program, or in an accredited or CFPC - RCPSC- accredited residency program located in Canada. If an individual was in an AOA- approved residency program at the time that program achieved ACGME Initial Accreditation, would that individual be eligible for -accredited appointment to an ACGME fellowship program? [Common Program Requirement -Year Common Program ; One III.A.2 III.A.] Requirement: Will residents who have completed a Examples of such training include emergency - pediatrics, family medicine - medicine combined residency program not -pediatrics -child psychiatry. The ACGME website now preventive medicine, and psychiatry accredited by the ACGME be eligible s individually accredited. If component lists these programs as Combined Specialty Tracks – -accredited, - for appointment to an ACGME each of the programs participating in the combined programs is ACGME residents enrolled in the combined residency program will be eligible for transfer into accredited fellowship program? -accredited residency program and graduates another ACGME of the program will be eligible [Common Program Requirement -accredited fellowship. While the ACGME does not accredit for appointment to an ACGME III.A.2.; One Year Common P rogram pediatrics), the ACGME combined programs (with the exception of internal medicine- Requirement III.A.] accredits each of the programs constituting the combined program. Therefore, graduates of these programs have completed their training in ACGME accredited residency programs. - Updated 08/2017 Common Program Requirements FAQs 28 9 of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME)

10 Answer Question I f a fellowship program is If unable to program is able to document that the Milestones assessments were requested from the a obtain Milestones assessments from core -compliance residency program director, the fellowship program will not be cited for non the core residency of a fellow entering even if the core program director does not provide the assessments. A new reporting feature fellowship in a given year , w ill the the is now available for fellowship programs within the Accreditation Data System (ADS). This program be cited for failing to obtain feature provides fellowship program directors access to the final Milestones report for an this information? active fellow's most recently completed . residency program There are a few scenarios in which these reports may not be available. The residency : [Common Program Requirement - ; One evaluation may be unavailable if the resident completed core residency training Milestones III.A.2.a) Year Common Program in a program not accredited by the ACGME, if the resident completed core residency ] Requirement: III.A.1. training prior to the Milestones implementation, or if the resident's previous tra ining could not be matched when entered into the program. For those residents without Milestones reports, programs must contact the specialty program director from the fellow's most recent residency program to obtain the required information. This new feature can be found within ADS by logging in and navigating to the program's "Reports" option. Residency Milestone Retrieval tab and selecting the Common Program Requirements FAQs Updated 08/2017 10 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

11 Answer Question The requirement that the GMEC or a subcommitte Why does the ACGME require the e of the GMEC review and approve all candidates under the “exceptionally qualified applicant” exception is to provide a check on GMEC or a subc ommittee of the candidates qualifying under the definition of this exception. A graduate medical education GMEC to review and approve all program is an educational program as sociated with health care providers that assume a candidates under the “exceptionally qualified applicant” exception? continued presence of a particular number of trainees at a particular knowledge, skill, and competency level, who both provide health care under supervision, and supervise more junior trainees. A gap in that particular number of qualified fellows may be disruptive to the : [Common Program Requirement normal provision of health care by these health care providers. In these circumstances, III.A.2.b).(2) ; One -Year Common program directors may perceive pressure from individuals within an institution to fill empty III.A.2.b) ] Program Requirement: slots for the sake of avoiding the disruption, but with less attention to a particular candidate’s knowledge, skill, and competency levels. The Review Committee sets the policy and the program determines if a candidate meets the Committee does not review or approve the stated criteria. Because the Review ponsoring determination of an exceptionally qualified applicant, the ACGME relies on the S Institution to provide oversight in the selection of exceptional candidates and monitoring of ght will promote programs’ exercise of due diligence in their performance. This oversi selection. The oversight need not be burdensome or intrusive; rather it provides an opportunity for the GMEC to collaborate with programs to ensure that these select level competency. - r entry candidates fulfill expectations fo Common Program Requirements FAQs Updated 08/2017 11 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

12 Question Answer I) provides accreditation oversight similar to that - ACGME International (ACGME The Why does the exception to the new -I-accredited residency programs evaluate resident fellowship eligibility requirements provided by the ACGME. ACGME provide for particular consideration of competency using the Milestones framework, determine resident progress through a Clinical -accredited ACGME International Committee based on multidimensional evaluation systems approved by the Competency training? -I, and report achievement of those Milestones semiannually to the -I. ACGME ACGME [Common Program Requirement s: Completion of an ACGME -I-accredited residency program is recognized and relied upon by III.A.2.b)* and II.A.2.b).(5) ; One -Year other authorities in the country in which the residency program is located, as licensing and -I training as s: well as regionally. Currently, however, no ABMS board accepts ACGME Common Program Requirement fulfilling training requirements for certification. ] .e) III.A.2.* and III.A.2 ACGME -I-accredited program graduates who have completed a residency in the core specialty and who have demonstrated clinical excellence, in comparison to peers, —the throughout training are considered to have fulfilled—by the nature of that training -Year “additional evidence of exceptional qualifications” requirement in III.A.2.b) (One Common Program Requirement III.A.2. ) *. Within six weeks of matriculation, programs will conduct a Milestones assessment of such a How will fellowship programs conduct -level fellow’s competency. That assessment will ensure that the fellow has at least entry a Milestones assessment of fellows competency in the Milestones, specialty. The program may choose to use the subspecialty appointed through the “exceptionally qualified applicant” pathway? the core specialty Milestones, or a combination. The assessment may be conducted by the fellowship Clinical Competency Committee (CCC) independently, or in collaboration with the sponsoring core program’s CCC. Programs may use one or more evaluation tools (e.g., [Common Program Requirement : global faculty evaluations, CEX, Simulation Center, OSCE, etc.) in this assessment. ; One .b).(5) III.A.2 -Year Common Program Requirement: III.A.2.e) ] International medical graduates who have passed the USMLE Steps 1 a nd 2 and obtained Is an international medical graduate ECFMG certification are eligible to take the USMLE Step 3. However, the USMLE program applying to an ACGME -accredited fellowship program as an recommends that for Step 3 eligibility, applicants should have completed, or be near graduate medical -acc exceptionally qualified applicant -graduate training year in a US redited completion of, at least one post required to pass Step 3 of the USMLE program that meets state board licensing requirements. International medical education not taken the USMLE Step 3, but graduates who adhere to this recommendation and have prior to appointment? who meet all of the other criteria for exceptionally qualif ied applicants, will be eligible for appointment to an ACGME -accredited fellowship if the applicable Review Committee : [Common Program Requirement permits these exceptions. -Year Common ; One III.A.2.b).(3) III.A.2.c) Program Requirement: ] Updated 08/2017 Common Program Requirements FAQs 12 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28

13 Answer Question Evaluation What is the role of the program The requirements regarding the CCC do not preclude or limit a program director’s participation on the CCC. The intent is to leave flexibility for each program to decide the best director on the CCC? structure for its own circumstances, but a program should consider: its program director’s [Common Program Requirement advocate, advisor, and confidante; the impact of the program /fellow other roles as resident : Common Program director’s presence on the other CCC members’ discussions and decisions; the size of the V.A.1. ; One -Year ] Requirement: V.A.1. -relevant factors. The program director has final program faculty; and other program responsibility for the program's evaluation and promotion decisions. /fellow’s The intent is to have enough members to broaden the input in a resident’s How can small programs have three members of the program faculty on evaluation. Program faculty can include more than the physician faculty such as other . For physicians and non- physicians who teach and evaluate the program’s residents /fellows the CCC? example, a fellowship may include faculty members from the core program or from required rotations in other specialties. : [Common Program Requirement ; One Common Program -Year V.A.1.a) ] Requirement: V.A.1.a) The requirements are intended to provide the program director with sufficient flexibility to physicians permitted to serve Are non - on the CCC? select individuals he/she believes have the background and experience needed to evaluate resident/fellow performance based on the Milestones. This may include health professionals who have extensive contact and experience with residents. Examples include, but are not [Common Program Requirement : limited to, nurses, PhDs, physicians’ assistants, and therapists. V.A.1.a).(1).(a) ; One -Year Common Program Requirement: V.A.1.a).(1).(a) ] What is the role of the programs and may, Program coordinators play a critical role in their residency program /fellowship evaluation system, provide valuable insight on coordinator on the CCC? through the program’s resident /fellow resident /fellow performance in areas such as interpersonal and communication skills, teamwork, and professionalism. Further, the program coordinator may, at the program : [Common Program Requirement director’s discretion, attend CCC meetings to support the activities of the CCC, such as ; One V.A.1.a).(1).(a) -Year Common /fellow collation of data on each resident , taking meeting minutes, recording decisions, and Program Requirement: V.A.1.a).(1).(a ] managing the submission of Milestones data to the ACGME. However, evaluation of resident /fellow competence related to the Milestones for patient care and medical knowledge is a vital responsibility of the CCC and these assessments should be made by individuals with background and experience in health care. Therefore, program coordinators, although they may admini stratively serve the CCC and take part in the 360 assessments of the resident/fellow, may not serve as voting members of the CCC. Common Program Requirements FAQs Updated 08/2017 13 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

14 Question Answer Program residents and chief residents in accredited years of the program may provide input What role can program residents, including chief residents who have not to the CCC Chair and/or the program director, outside the context of the CCC meetings, completed the program, play on the through the evaluation system. However, to ensure that residents’ peers are not providing CCC? promotion and graduation decisions, and that they are not involved in recommendations for remediation or disciplinary actions, these residents may not serve as CCC members or attend CCC meetings. : Program Requirement [Common ; One -Year Common V.A.1.a).(1).(b) Program Requirement: ] V.A.1.a).(1).(b) /fellows /fellow resident A must always be included on a P EC When would it be acceptable to not unless there are no residents on the /fellow include a resident enrolled in the program. The PEC must meet annually, even when there are no enrolled in the program, to evaluate and review the program. /fellows Program Evaluation Committee residents ? (PEC) [Common Program Requirement : V.C.1.a).(1) ; One -Year Common Program Requirement: V.C.1.a).(1) ] No. Programs in which some or all graduates take the applicable AOA certifying exam may specific Program - The specialty not achieve the required minimum “take rate" for the applicable ABMS board examination as Requirements stipulate a minimum percentage of program graduates that -specific Program Requirements. When this occurs the program will specified in the specialty must take the certifying examination not receive a citation and the program’s accreditation status will not be adversely impacted offered by the applicable ABMS -compliance with this requirement. The ACGME believes that the goal of on the basis of non member board. Must osteopathic -accr ACGME /fellowship edited residency education is to produce physicians who seek and graduates take the ABMS board receive certifying board certification, recognizing that some graduates will be eligible for both examination rather than the l be exams and will have the freedom to choose which exam to take. This expectation wil examination offered by the applicable addressed in the Common Program Requirements at the time of their next major revision. AOA certifying board? Updated 08/2017 Common Program Requirements FAQs of Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 28 14

15 Answer Question The Learning and Working Environment The ACGME requires that programs and their Sponsoring Institutions monitor resident/fellow According to the Common and clinical and educational work hours to ensure they comply with the requirement Institutional Requirements, programs s, but does and Sponsoring Institutions must have not specify how monitoring and tracking of clinical and educational work hours should be accomplished. The ACGME does not mandate a specific monitoring approach, since the oversight for clinical and educational work hours [Common Program titution. For ideal approach should be tailored to each program and its Sponsoring Ins example, the approach best suited for neurological surgery will be different from the one Requirement II.A.4.j).(2) and Institutional Requirement IV.J.]. Does most appropriate for preventive medicine, dermatology, or pediatrics, etc. this mean that a Sponsoring Institution must do electronic, “real -time” monitoring of clinical and educational work hours for all accredited programs? [Common Program Requirement: II.A.4.j).(2); Institutional Requirement: IV.J.] The philosophical statement in the interest is an essential component of professionalism for physicians, but Effacement of self - - does not imply that physicians should jeopardize their own well Introduction to Section VI references -being to prioritize the well eff being of their patients. Prioritization of physician well is important in ensuring that acement of self -interest as a -being component of professionalism. Isn’t physicians remain fit to provide care for their patients. Requirement VI.C.2. requires a this in conflict with the emphasis on process to ensure continuity of care in the event that a resident or fellow is unable to perform their patient care duties, and Requirem -being reflected in the physician well ent VI.B.5. addresses the expectation that new requirements? residents/fellows and faculty members demonstrate responsiveness to patient needs that -interest and emphasizes that in some circumstances, the best interests of supersedes self ioning the patient’s care to another qualified and rested the patient may be served by transit [Common Program Requirement: VI. provider. Year Common Introduction; One- Program Requirement: VI. Introdu ction] Updated 08/2017 Common Program Requirements FAQs 15 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28

16 Question Answer Are the new requirements related to The new requirements related to patient safety and quality improvement are not limited to patient safety and quality improvement inpatient experiences, and thus are inclusive of care provided in outpatient settings. intended to apply solely in inpatient settings? [Common Program Requirement: -Year Common Program VI.A.1.; One R equirement: VI.A.1.] specific data is desirable, but not required. The requirement With regards to the requirement Providing individual, specialty - relating to provision of data to seeks to ensure that quality metrics used by the institution are shared with residents/fellows members. Examples of metrics include, but are not limited to, those provided by residents/fellows and faculty members and faculty the following: Hospital Consumer Assessment of Healthcare Providers and Systems on quality metrics and benchmarks related to their patient populations, is (HCAHPS), Centers for Medicaid and Medicare Services (CMS), Press Gainey, and Quality Improvement Program (NSQIP). National Surgical the expectation that individual data regarding clinical performance must be provided? [Common Program Requirement: -Year Common VI.A.1.b).(2).(a); One Program Requirement: VI.A.1.b).(2).(a)] How should the appropriate level of of progressive responsibility for patient care to residents and fellows is an The assignment supervision be determined for each essential component of graduate medical education and is necessary to prepare residents and fellows to be independent practitioners. While decisions regarding the appropriate level resident or fellow? of supervision are made by the program director and faculty, the Common Program Requirements provide a framework for the progression from direct supervision to oversight. [Common Program Requirements: The level of supervision for an individual resident or fellow is determined both VI.A.2.c) -VI.A.2.c).(3); One -Year by the abilities Common Program Requirements: of the resident and the needs of each patient. Therefore, the level of supervision required for a resident or fellow will have to vary based on the circumstances. VI.A.2.c) - c).(3)] Common Program Requirements FAQs Updated 08/2017 16 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

17 Answer Question How can residents and fellows identify Residents and fellows must know who the accountable attending physician is prior to sions on behalf of a patient. The program and institution are the accountable attending physician making any clinical deci responsible for providing that information to all residents and fellows. Residents and fellows for each patient for whom they are are responsible for keeping the accountable physician informed. providing care? [Common Program Requirement: -Year Common VI.A.2.a).(1); One Program Requirement: VI.A.2.a).(1)] This communication may occur in - person or via portal, fax, text, phone, or e - mail. It is How do residents communicate with essential that each patient’s primary physi the accountable physician? cian be listed in the patient’s chart. If that information is not included in the chart, the patient should be asked to provide the name of their primary physician. If the patient does not have one, a determination regarding who will [Common Program Requirement: for overall care must be made and documented in the patient’s chart. assume responsibility VI.A.2.a).(1); One -Year Common Program Requirement: VI.A.2.a).(1)] How will compliance with the Approaches for monitoring and documenting are left to the discretion of program and institutional leadership, who should decide on the optimal way to ensure accuracy of requirement regarding accurate reporting. reporting of clinical and educational work hours, patient outcomes, and clinical experience data be assessed? [Common Program Requirement: VI.B.4.f); One -Year Common Program VI.B.4.f)] : Requirement Updated 08/2017 Common Program Requirements FAQs Page 17 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28

18 at is work compression and why is Wh In the context of the Common Program Requirements, work compression occurs when it addressed in the new requirements? physicians are required to do the same amount of work in less time, and has been addressed in the new requirements to ensure that programs consider the impact of work compression on well -being and how the impact can be minimized. To help frame the issue, [Common Program Requirement: a review of the literature relevant to work compression is provided below. -Year Common VI.C.1.b); One Program Requirement: VI.C.1.b)] Research has found high workload and work compression associated with reduced empathy in medical interns (Bellini, 2002), with residents selectively discharging older inpatients earlier (Hilson, 1993), with increased risk for mortality (Hilson, 1992, Ong 2007) and readmission (Thanarajasingam, 2012), lower patient satisfaction (Griffith, 1998), greater use of diagnostic tests (Griffith, 1996), and shifting from active patient care to monitoring to keep workload manageable (Cao, 2008). Studies of the effect of workload on resident outcomes found reduced educational participation with higher workload (Arora, 2008), an inverse relationship between workload and intern perceptions of the quality of thei r education and their own professionalism (Auger, 2012), and improved conference attendance with a limit on patient admissions (Thanarajasingam, 2012). Bellini LM, Baime M, Shea JA. 2002. Variation of mood and empathy during internship. 287:3143– JAMA 46 Hilson SD, Rich EC, Dowd BE, et al. 1993. The impact of intern workload on length of hospital stay for elderly patients. Gerontol. Geriatr. Educ. 14(2):33– 40 Hillson SD, Rich EC, Dowd B, et al. 1992. Call nights and patients care: effects on inpatients at one teaching hospital. J. Gen. Intern. Med. 7(4):405– 10 Ong M, Bostrom A, Vidyarthi A, et al. 2007. House staff team workload and organization effects on patient outcomes in an academic general internal medicine inpatient service. 47– 167(1): 52 Arch. Intern. Med. Thanarajasingam U, McDonald FS, Halvorsen AJ, et al. 2012. Service census caps and unit -based admissions: resident workload, conference attendance, duty hour compliance, and patient safety. 27 Mayo Clin. Proc. 87(4):320– Griffith CH 3rd, Wilson JF, R ich EC. 1998. The effect at one teaching hospital of interns’ workloads on the satisfaction of their patients. 73(4):427– Acad. Med. 29 Griffith CH 3rd, Desai NS, Wilson JF, et al. 1996. Housestaff experience, workload, and test Acad. Med. 8 71(10):1106– ordering in a neonatal intensive care unit. Cao CG, Weinger MB, Slagle J, et al. 2008. Differences in day and night shift clinical performance in anesthesiology. 90 – 50(2):276 Hum. Factors Common Program Requirements FAQs Updated 08/2017 18 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

19 Question Answer call workload of medical - Arora VM, Georgitis E, Siddique J, et al. 2008. Association of on interns with sleep duration, shift duration, and participation in educational activities. JAMA 53 300(10):1146– Auger KA, Landrigan CP, Gonzalez del Rey JA, et al. 2012. Better rested, but more - . Jul stressed? Evidence of the effects of resident work hour restrictions. Acad Pediatr - 43 Aug;12(4):335 Can residents/fellows be required to The requirements do not specify whether residents/fellows will be required to use vacation or sick time for medical, dental, and mental health appointments. Programs should comply take vacation or sick time when with their institution’s policies regarding tim e off for such appointments. attending appointments during scheduled working hours? [Common Program Requirement: -Year Common VI.C.1.d).(1); One Requirement: VI.C.1.d).(1)] Program Can residents/fellows be encouraged The intent of this requirement is to ensure that residents and fellows are able to attend to schedule medical, mental health, appointments as needed, and that their work schedule not prevent them from seeking care and dental care appointments on days when they need it, including during scheduled call days. Programs must not place they are not assigned call? restrictions on when residents and fellows may schedule these appointments, nor place pressure on them to schedule appointments on days when they are not assigned call. [Common Program Requirement: VI.C.1.d).(1); One -Year Common Program Requirement: VI.C.1. d).( 1)] The requirement is intended to ensure that residents and fellows have immediate access at How can programs located in areas all t imes to a mental health professional (psychiatrist, psychologist, Licensed Clinical Social where 24/7 in- person access to Worker, Primary Mental Health Nurse Practitioner, or Licensed Professional Counselor) for mental health professionals is not mental health urgent or emergent mental health issues. Access to a psychiatrist or other possible comply with this requirement? professional in the Emergency Department satisfies the expectation for 24/7 access to emergency care. In addition, telemedicine, or telephonic means may be utilized to satisfy this requirement. [Common Program Requirement: VI.C.1.e).(3); One -Year Common Program Requirement: VI.C.1.e).(3)] Updated 08/2017 Common Program Requirements FAQs 19 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 28 of

20 Question Answer Transitions of care are critical elements in patient safety and must be organized such that What are the ACGME’s expectations complete and accurate clinical information on all involved patients is transmitted between regarding tra nsitions of care, and how the outgoing and incoming individuals and/or teams responsible for the specific patient or should programs and institutions of patients. Programs and institutions are expected to have a documented process in monitor effective transitions of care group and minimize the number of such place for ensuring the effectiveness of transitions. Scheduling of on- call assignments should transitions? be optimized to ensure a minimal number of transitions, and there should be documentation of the process involved in arriving at the final schedule. Specific schedules will depend upon various factors, including the size of the program, the acuity and quantity of the workload, [Common Program Requirement: and the level of resident/fellow education. -Year Common Program VI.E.3.; One Requirement: VI.E.3.] How do the hours in ACGME common clinical the The clinical and educational work hour requirements pertain to all required -learning). When research is a formal part program (the only exceptions are reading and self and educational work hour of the residency/fellowship and occurs during the accredited years of the program, research requirements apply to research activities? st comply with the hours or any combination of research and patient care activities mu weekly limit on hours and other pertinent clinical and educational work hour requirements. [Common Program Requirement: -Year Common Program VI.F.; One When programs offer an additional research year that is not part of the accredited years, or Requirement: VI.F.] time, making these hours identical to when residents/fellows conduct research on their own other personal pursuits, these hours do not count toward the limit on clinical and educational -required -directed research and program work hours. The combined hours spent on self activities should meet the test for a reasonably rested and alert resident/fellow when he or she participates in patient care. Some programs have added clinical activities to “pure” research rotations, such as having and clinical research residents/fellows cover “night float.” This combination of research assignments could result in hours that exceed the weekly limit and could also seriously undermine the goals of the research rotation. Review Committees have traditionally been th significant patient care concerned that required research not be diluted by combining it wi assignments. Common Program Requirements FAQs Updated 08/2017 20 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

21 Answer Question Is there a provision for training There is nothing in the requirements that prevents a program from providing an alternate pathways with alternative schedules to pathway based on the needs of individuals, as long as the pathway adheres to other relevant dimensions of the requirements, including the maximums specified for clinical accommodate the needs of those with experience and education. the ability to become excellent physicians but an inability to take on the demanding usual schedule descr ibed in the requirements? [Common Program Requirement: VI.F.; One -Year Common Program Requirement: VI.F.] Clinical and educational work hours are defined as all clinical and academic activities related What is included in the definition of and outpatient clinical care, in- to the residency/fellowship program. This includes inpatient clinical and educational work hours house call, short call, night float and day float, transfer of patient care, and administrative under the requirement limiting them to activities related to patient care, such as completing medical records, ordering and 80 hours per week? reviewing lab tests, and signing orders. For call from home, time devoted to clinical work done from home and time spent in the hospital after being called in to provide patient care [Common Program Requirement: count toward the 80- hour weekly limit. Types of work from home that must be counted VI.F.1.; One -Year Common Program include using an electronic health record and taking calls. Reading done in preparation for Requirement: VI.F.1.] the following day’s cases, studying, and research done from home do not count toward the 80 hours. Hours spent on activities that are required in the accreditation requirements, such as hip on a hospital committee, or that are accepted practice in residency/fellowship members programs, such as residents’/fellows’ participation in interviewing residency/fellowship candidates, must be included in the count of clinical and educational work hours. Time residents and fellows devote to military commitments counts toward the 80- hour limit only if that time is spent providing patient care. Common Program Requirements FAQs Updated 08/2017 21 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

22 Question Answer If attendance at the conference is required by the program, or if the resident/fellow is a If some of a program’s representative for the program (e.g., he/she is presenting a paper or poster), the hours residents/fellows attend a conference that requires travel, how should the conference should be included as clinical and educational work hours. Travel time and non- hours while away do not meet the definition of “clinical and educational work hours” in the hours be counted for clinical and ACGME requirem ents. educational work hour compliance? [Common Program Requirement: VI.F.1.; One -Year Common Program Requirement: VI.F.1.] The intent of the requirement is to ensure that programs recognize the need to balance What are the expectations in terms of a program structure that balances educational experiences with time away from the program. If an imbalance exists, it is resident/fellow educational ironment, requiring expected that it would be manifest in other aspects of the learning env the program to make adjustments as needed. opportunities with opportunities for -being? rest and personal well [Common Program Requirement: VI.F.2.a); One -Year Common VI.F.2.a)] Program Requirement: While it is expected that residents’ and fellows’ schedules will be structured to ensure they What is meant by “should have eight hours off”? are provided with a minimum of eight hours off between scheduled work periods, it is recognized that individual residents or fellows may choose to remain beyond their scheduled [Common Program Requirements: off period, to care for a patient. The or return to the clinical site during this time- time, -VI.F.2.b).(1); One -Year VI.F.2.b) requirement preserves the flexibility for the resident or fellow to make those choices. It is Common Program Requirements: terrent for also noted that the 80 -hour weekly limit (averaged over four weeks) is a de VI.F.2.b) – VI.F.2.b).(1)] scheduling fewer than eight hours off between clinical and education work periods, as it would be difficult for a program to design a schedule that provides fewer than eight hours off without violating the 80 -hour rule. It is important to reme mber that when an abbreviated rest period is offered under special circumstances, the program director and faculty members must monitor residents/fellows for signs of excessive fatigue. Common Program Requirements FAQs Updated 08/2017 22 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

23 Question Answer hour time call resident/fellow remains - If a post - off period begins when the resident/fellow leaves the hospital, regardless The 14 - site for up to four additional hours of when the resident was scheduled to leave. on- as described in the requirements, -hour time- off does the required 14 period begin at the end of the scheduled 24- hour period, or when the resident leaves the hospital? [Common Program Requirements: -Year VI.F.2.c), VI.F.3.a).(1); One am Requirements: Common Progr VI.F.2.c), VI.F.3.a).(1)] hour day off. Since the common clinical and The common clinical and educational work hour requirements specify a 24 - Many Review Committees have recommended that this day off should ideally be a calendar educational work hour requirements day (i.e., the resident/fellow wakes up in his or her home and has a whole day available). residents/fellows must be state that provided with one day in seven free Review Committees have also noted that it is not permissible to have the day off regularly or from all responsibilities, with one day frequently scheduled on a resident’s/fellow’s post -call day, but understand that in smaller hour defined as one continuous 24- - programs it may occasionally be necessary to have the day off fall on the post call day. Note period, how should programs interpret that in this case, a resident/fellow would need to leave the hospital post -call early enough to this requirement if the “day off” occurs allow for 24 hours off from clinical and educational work. Because call from home does not after a resident’s/fellow’s on- call day? require a rest period, the day after home call may be used as a day off. [Common Program Requirement: -Year Common VI.F.2.d); One Program Requirement: VI.F.2.d)] - hour clinical and educational work period may Residents/fellows who have completed a 24 What activities are permitted during spend up to an additional four the four hours allowed for activities hours on- site to ensure an appropriate, effective, and safe related to patient safety and/or transition of care (including rounds), to maintain continuity of patient care, and to participate -hour period, residents/fellows in educational activities, such as conferences. During this four resident education? must not be permitted to participate in the care of new patients in any patient care setting; must not be assigned to outpatient clinics, including continuity clinics; and must not be [Common Program Requirements: surgery. assigned to participate in a new procedure, such as an elective scheduled VI.F.3.a).(1) -VI.F.3.a).(1).(a); One - Residents/fellows who have satisfactorily completed the transition of care may attend an Year Common Program -hour period. educational conference that occurs during this four - s: VI.F.3.a).(1) Requirement VI.F.3.a).(1).(a)] Updated 08/2017 Common Program Requirements FAQs 23 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 28 of

24 Answer Question Programs interested in extending the clinical and educational work hours for specific Can clinical and educational work hours for surgical chief residents be hour exception” to request an increase of rotations for their chief residents can use the “88- up to 10 percent in clinical and educational work hours on a program extended to 88 hour s per week? -by-program basis, with endorsement of the Sponsoring Institution’s Graduate Medical Education Committee (GMEC) and the approval of the Revi ew Committee. If approved, the exception will be [Common Program Requirements: reviewed annually by the Review Committee. VI.F.4.c) -VI.F.4.c).(2); One -Year Common Program Requirement s: VI.F.4.c) -c).(2)] A request for an exception must be based on a sound educational justification. Most Review ception. The Committees categorically do not permit programs to use the 10 percent ex Review Committee for Neurological Surgery is currently the only Review Committee that allows exceptions. - specific increase in clinical and educational work hours What qualifies as a “sound The ACGME specifies that a rotation educational justification” for a rotation- above 80 hours per week can be granted only when there is a very high likelihood that this will improve residents’/fellows’ educational experiences. This requires that all hours in the specific increase in the weekly clinical extended work week contribute to resident/fellow education. and educational work hour l imit by up to 10 percent? Programs may ask for an extension that is less than the maximum of eight additional weekly hours, and/or for a subgroup of the residents/fellows in the program. [Common Program Requirements: -VI.F.4.c).(2); One -Year VI.F.4.c) Common Program Requirement s: VI.F.4.c) - c).(2)] Common Program Requirements FAQs Updated 08/2017 of 24 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) 28

25 Question Answer In addition to the 80 - The hours spent moonlighting are counted toward the total hours work hour maximum ed for the week. No weekly limit, do all other clinical and other clinical and educational work hour requirements apply, but the following requirements do: educational work hour rules apply to moonlighting (maximum clinical and educational work period length, VI.F.5.a) “Moonlighting must not interfere with the ability of the resident to achieve the goals minimum time off between shifts, and must not interfere with the resident’s fitness and objectives of the educational program, etc.)? for work nor compromise patient safety.” [Common Program Requirements: VI.B.4.c).(2) “The program director, in partnership with the Sponsoring Institution, VI.B.3.- -Year Common -c); One VI.F.5.a) y and personal must provide a culture of professionalism that supports patient safet -b)] Program Requirements: VI.F.5.a) responsibility. Residents and faculty members must demonstrate an understanding of their - and family -centered care; safety and welfare of personal role in the: provision of patient patients entrusted to their care, including the ability to r eport unsafe conditions and adverse events; assurance of their fitness for work, including: management of their time before, during, and after clinical assignments; and, recognition of impairment, including from illness, fatigue, and substance use, in them selves, their peers, and other members of the health care team.” the averaging of in The objectives for allowing How many times in a row can a house call (in all specialties except internal - resident/fellow take call every other medicine) is to offer flexibility in scheduling, not to permit call every other night for any extended length of time, even if done in the interest of creating longer periods of free time night? on weekends or later in the month. For example, it is not permissible for a resident/fellow to be on call every other night for two weeks straight and then be off for two weeks. [Common Program Requirement: -Year Common Program VI.F.7.; One Requirement: VI.F.7.] No. The requirement for one day free every week prohibits being assigned home call for an Is it permissible for residents/fellows to take call from home for extended entire month. Assignment of a partial month (more than six days but fewer than 28 days) is possible. However, keep in mind that call from home is appropriate if service intensity and periods, such as a month? frequency of being called is low. Program directors are expected to monitor the intensity and l through periodic assessment of workload and intensity of workload resulting from home cal [Common Program Requirement: in-house activities. -Year Common VI.F.8.a); One Program Requirement: VI.F.8.a)] Common Program Requirements FAQs Updated 08/2017 Page ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 25

26 Answer Question home 1 residents take at - lly allowed to take at Can PGY - home call because appropriate - PGY - 1 residents are not initia supervision (either direct supervision or indirect supervision with direct supervision call, and if so, what are the work hour restrictions for this? -home call. However, a immediately available) is not possible when a resident is on at Review Committee may specify t he circumstances and achieved competencies required for residents to progress to be supervised indirectly with direct supervision available at some [Common Program Requirement: -1 year. Program directors should point after the beginning, but before the end, of the PGY VI.A.2.e).(1).(a)] lty review the specia specific requirements for further clarification. - The new requirements specify that The requirements acknowledge the changes in medicine, including electronic health records, and the increase in the amount of work residents and fellows choose to do from clinical work done from home must count toward the 80- home. Resident decisions to complete work at home should be made in consultation with hour weekly the resident’s/fellow’s supervisor. In such circumstances, residents/fellows should be maximum, averaged over four weeks. mindful of their professional responsibility to complete work in a timely manner and to Why was this change made? maintain patient confidentiality. The requirement provides flexibility for residents/fellows to do this while ensuring that the time spent completing clinical work from home is [Common Program Requirement: accomplished within the 80- hour weekly maximum. VI.F.1.; On e-Year Common Program Requirement: VI.F.1.] Types of work from home that must be counted include using an electronic health record What are the expectations regarding and responding to patient care questions. Reading done in preparation for the following tracking and monitoring clinical work done from home? day’s cases, studying, and research done from home do not count toward the 80 hours. [Common Program Requirements: Residents and fellows are expected to track the time spent on these activities and report this VI.F.1., VI.F.8.a); One -Year Common time to the progr am director. The program director then will use this information when Program Requirements: VI.F.1., developing schedules to ensure that residents and fellows are not exceeding 80 hours per VI.F.8.a)] week, averaged over four weeks. Decisions about whether to report brief periods devoted to clinic al work (e.g., a phone call that lasts just a couple of minutes) are left to the individual resident or fellow. There is no requirement regarding how this time is tracked and documented and no expectation that the program director assume a role in verifying the time reported by the residents and fellows. Common Program Requirements FAQs Updated 08/2017 26 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

27 Answer Question Which requirements apply to time in ome (home or pager call), the time the resident/fellow spends in the For call taken from h hospital after being called in counts toward the weekly clinical and educational work hour the hospital after being called in from limit. The only other numeric clinical and educational work hour requirement that applies is home call? one day free of clinical and educational work every week that must be free of all patient the -home call. Program directors must monitor the care responsibilities, which includes at [Common Program Requirements: of the -home call through periodic assessment intensity and workload resulting from at -b); One -Year Common VI.F.8.a) house frequency of being called into the hospital, and the length and intensity of the in- -b)] s: VI.F.8.a) Program Requirement activities. -home call return to the hospital to care for patients, a When residents/fellows assigned to at new time- off period is not initiated, and therefor e the requirement for eight hours between shifts does not apply. The frequency and duration of clinical work done from home and time returning to the hospital must not preclude rest or reasonable personal time for residents/fellows. General Questions Averaging must occur by rotation. This is done over one of the following: a four - week period; How should the averaging of the a one- month period (28- 31 days); or the period of the rotation if it is shorter than four weeks. clinical and educational work hour -hour weekly requirements (e.g., 80 s are shorter than four weeks in length, averaging must be made over these When rotation limit, one day free of clinical and shorter assignments. This avoids heavy and light assignments being combined to achieve educational work every week, and call compliance. no more frequently than every third night) be handled? For example, what ion or leave If a resident/fellow takes vacation or other leave, the ACGME requires that vacat should be done if a resident/fellow days be omitted from the numerator and the denominator for calculating clinical and takes a vacation week? educational work hours, call frequency, or days off. The requirements do not permit a across high “rolling” average, because this may mask compliance problems by averaging and low clinical and educational work hour rotations. The rotation with the greatest hours and frequency of call must comply with the common clinical and educational work hour requirements. Common Program Requirements FAQs Updated 08/2017 27 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

28 Answer Question The statement “Programs, in partnership with their Sponsoring Institutio ns,” throughout Many of the new requirements address responsibiliti es that must be Section VI reflects the need for programs and institutions to work together and recognize that institutional support will be necessary for programs to comply with the new shared by programs and Sponsoring requirements. The next revision of the Institutional Requirements wil l include changes to Institutions. Will the Institutional align the Institutional Requirements with the new Section VI of the Common Program Requirements be revised to address the Sponsoring Institution’s Requirements. responsibilities in these areas? Can the clinical and educational work The ACGME expects that clinical and educational work hours in any given four - week period comply with all applicable requi rements. This includes months with holidays, during which hour requirements be relaxed over institutions may have fewer staff members available. During the holiday period, scheduling holidays or during other times when a during hospital is short for the rotation (generally four weeks or a month) must comply with the common and -staffed, periods when some residents/fellows specialty -specific clinical and educational work hour requirements. Further, the schedule are ill or on leave, or when there is an during the holidays themselves may not violate common clinical and educational work hour requirements (such as the requirement for adequate rest between clinical and educational unusually large patient census or ), or specialty demand for care? work periods specific requirements. - The clinical and educational work hour limits of the program in which the resident/fellow What determines clinical and educational work hour limits for rota tes apply to all residents/fellows, both those in the program and rotators from another specialty. This expectation also applies when a program has an exception, but it helps to residents/fellows who rotate in another remember that the standard defines the maximum allowable hours, not required hours or accredited program? hours for all residents/fellows, so that it is always possible to work fewer hours than the limit. Common Program Requirements FAQs Updated 08/2017 28 ©2017 Accreditation Council for Graduate Medical Education (ACGME) of 28 Page

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