ACGME Response to COVID-19

The Accreditation Council for Graduate Medical Education (ACGME) has developed an official response to the pandemic to guide sponsoring institutions and participating sites. Below, we present some highlights; read the full response here.


Medical School Early Graduates

Many health care facilities in the United States are facing unprecedented challenges. In light of these challenges, public information has suggested that some U.S. allopathic and osteopathic medical schools are hoping to assist these challenged health care centers by planning for early graduation of 4th-year medical students in order to facilitate their participation in the pandemic.

The ACGME does not have a position on the early graduation of medical students. The ACGME is concerned that there are ramifications for early graduation of medical students including but not limited to CMS reimbursement for direct graduate medical education (DGME)/indirect medical education (IME)  and match participation agreements.

The ACGME has established three phases or stages during the pandemic for graduate medical education (GME). Sponsoring Institutions and their participating sites are functioning at one of three stages along a continuum:

  • Stage 1 – “business as usual”
  • Stage 2 – increased but manageable clinical load
  • Stage 3 – increase in volume and/or severity of illness creating extraordinary circumstances in which route care education and delivery must be revised to focus only on patient care

Stage 1: “Business as usual”

In this stage, there is no significant disruption of patient care or educational activities, but planning is under way for increased clinical demands (stage 2). There is no redeployment of fellows, and the following ACGME activities are suspended:

  • Site visits (accreditation and CLER)
  • Self-study
  • ACGME surveys

Telemedicine requirements are in place.

Stage 2: Increased clinical demands guidance

In addition to the events recorded in stage 1 (suspended ACGME activities, telemedicine requirements in place), in this stage some residents/fellows need to shift patient care duties. Some education activities are cancelled. In Stage 2, fellows may be reassigned to act as attendings. Each institution will have own rules but, in order to transition from the fellow status to work as an attending in one's base specialty, a credentialing process may need to be initiated via the local GME and at the request of the department. Residents and fellows still need to abide by work hour limits, supervision, resource, and training requirements.

The ACGME will be flexible in regard to residents/fellows who are reassigned and fail to accrue required minimums for graduation. The Clinical Competency Committee is ultimately responsible for assessing a prospective graduating fellow’s level of competence. The ACGME will leave at the discretion of the program director, the CCC, and institution if the fellow is considered competent and is allowed to graduate.

The ACGME also will permit flexibility in regard to educational program changes and review committee evaluation of disruptions. However, if disruptions of educational activities exceed 30 days, the relevant review committee executive director should be contacted.

The following ACGME activities are suspended:

  • Site visits (accreditation and CLER)
  • Self-study
  • ACGME surveys

Stage 3: Pandemic emergency status guidance (30 day limit) 

The declaration of Stage 3 is an institutional-level decision; the institution must inform ACGME before implementation and conduct communication to all PD’s and coordinators.

In this stage, all or most of the residents/fellows need to be shifted to patient care and the majority of educational activities are suspended. Fellows are allowed to function in their core specialty.

Abuse of residents, use of residents in areas in which they do not have the knowledge and skills to provide the services demanded, or failure to comply with any of these expectations - (1)adequate resources/training, (2) adequate supervision, (3) maintaining work hours, and (4) function in core specialty - may result in ACGME intervention. 

Detailed communication needs to be initiated with the fellows regarding how long the re-deployment will last and the impact on the ability to complete the program on time. The following ACGME activities are suspended:

  • Site visits (accreditation and CLER)
  • Self-study
  • ACGME surveys

Download our infographic here.


Telemedicine

Telemedicine requirements are currently in effect:

“The ACGME has accelerated the use of the Common Program Requirements for supervision of telemedicine visits carried out by residents and fellows, originally scheduled to go into effect July 1, 2020.  Instead, effective immediately, the ACMGE will permit residents/fellows to participate in the use of telemedicine to care for patients affected by the pandemic.” 

There are 2 different methods of supervision within this model. 

  1. Direct Supervision: The supervising physician must be in the room with the resident or fellow when the visit is conducted OR the supervising physician is not physically present with the resident or fellow and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technologyAttendings can only bill for the time that they spend with the patient.
  2. Indirect Supervision with Direct Supervision Immediately Available: The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities and is available to provide direct supervision.  Attendings cannot bill for encounters conducted with indirect supervision. 

Other Resources

Impact on Interviews

Programs may decide to use alternative methods to interview applicants including virtual interviews through various platforms of the institution’s choosing.

American Board of Anesthesiology (ABA)

As reported in a March 13 news announcement, the ABA has made the following adjustments.

In-Training Examination (ITE)

The ABA has provided 3 options regarding the ITE exam for current fellows:

  1. Can take the ITE as scheduled (March 26, 27th, 28th).
  2. The exam can be postponed for all fellows on May 28, 29, or 30th. (These might be canceled as well.)
  3. The exam can be cancelled for all fellows.

As many fellows applied for the exams that have been cancelled and cancellations are likely to continue, the ABA has issued a statement that they are looking into creative ways to address the situation.

Absence from work secondary to COVID

  • The ABA states that any time spent in mandated or self-quarantine due to COVID-19 will be counted as clinical hours for the fellow; however, this policy may not apply to trainees who are quarantined because of discretionary travel to high-risk areas.

COVID-positive fellows who miss training may request to have the additional absence excused per the  Absence from Training Policy, which allows fellows to miss 20 days of training per year without extending training.

Education

Many programs are utilizing tele-platforms to continue their fellows’ educational opportunities. These platforms can be used as the discretion of the fellowship program and may be used to conduct lectures, journal clubs, chapter reviews, etc. Resources for fellows include compiling educational materials and developing a platform for access to collective knowledge as well as live educational activities to increase virtual interaction.

Research

Non-essential research has been suspended at many institutions. It is understandable that fellows/residents may not be able to complete in-process research secondary to these suspensions.


Thank you to Lynn Kohan, MD, and Magda Anitescu, MD, PhD, for providing these resources.