ACGME Adopts New Mechanism to Address Residents' ConcernsACGME Procedure for Rapid Response to Alleged Egregious Accreditation Violations or Catastrophic Institutional Events FREE

In the February 18 Resident Forum column, we reported on the issue of collective negotiations between resident physicians and their residency programs. The question being considered by the National Labor Relations Board is whether residents would be protected under US labor laws if they negotiated working conditions with their programs. Absent a voice in these negotiations, some residents feel that they have little opportunity to improve their working conditions and little recourse when faced with mistreatment. Some of the criticism for the status quo has fallen on the Accreditation Council for Graduate Medical Education (ACGME), which accredits the 7619 residency programs.

One of the criticisms has been that the ACGME's process for reviewing complaints against residency programs is too slow. Residents have argued that too often the process takes so long that the resident who originally filed the complaint has completed residency before the complaint was fully addressed. To address this specific concern, the ACGME recently enacted a "rapid response mechanism" for some complaints. The full text of this procedure is presented below. The ACGME is also reviewing its institutional requirements to address other concerns; we will report on these in a future Resident Forum.

The occurrence of an alleged egregious accreditation violation or a catastrophic institutional event that because of its urgency, must be addressed outside the established processes of the ACGME should be reported promptly to the Executive Director of the ACGME. Any component of the ACGME accreditation process having knowledge of such an occurrence, including residents in training or member organizations, has a responsibility to report the matter promptly and directly to the ACGME Executive Director who will initiate an investigation to determine credibility and degree of urgency of the matter. Whenever the Executive Director determines that the matter disclosed is of sufficient importance and urgency to require expedited action, the following process will be initiated:

First, the Executive Director will make direct contact with the appropriate responsible individuals and will request a formal and prompt response.

Second, the Executive Director will consult with a committee composed of the Executive Director, the Chair of the Institutional Review Committee, and the Chair of the Residency Review Committee Council. This committee may decide that an immediate on-site survey and consultation should occur.

Third, if the committee decides that an immediate on-site survey and consultation should occur, an ad hoc survey team, composed of 3 knowledgeable individuals, will be appointed by the Executive Director and the other committee members. The ad hoc survey team will be selected from current and former members of the ACGME, Institutional Review Committee, or the Residency Review Committees.

Fourth, the ad hoc survey team will conduct a focused survey of the institution considering all matters related to the alleged egregious or catastrophic accreditation violation. At the conclusion of the survey, the team will submit a written report to the institution and the Executive Director. The Executive Director will forward the report to the Institutional Review Committee or the relevant Residency Review Committee for consideration at the next regular meeting.