ACGME, AOA, AACOM Unify

[odoreater]

Just released:

http://www.acgme.org/acgmeweb/portals/0/PDFS/Nasca-Community/SingleAccreditationRelease2-26.pdf


Colleagues,

Earlier today, the ACGME, AOA, and AACOM agreed to a single accreditation system for graduate medical education (GME) programs in the U.S. A news release on this announcement is now available on our website and has been distributed publically.

More information about this significant development will be announced during the ACGME Annual Educational Conference in Washington, DC later this week, and, as they unfold, further details will be posted on the ACGME website.

Respectfully,

Timothy M. Goldfarb, MHA, Chair, ACGME Board of Directors
and
Thomas J. Nasca, MD, MACP, Chief Executive Officer, ACGME

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[sylvanthus]

Never thought Id see it happen, pretty crazy. Good thing I busted my arse to get into a good MD residency and now any podunk, formerly DO EM residency in the middle of nowhere is soon going to be ACGME accredited. Ah well, its good for a lot of people and I am genuinely happy it is going through, just makes my effort seem a bit wasted is all. Will be interesting to see how it all plays out and I am glad I likely do not have to worry about resolution 42 any longer.

 

[Makati2008]

Never thought Id see it happen, pretty crazy. Good thing I busted my arse to get into a good MD residency and now any podunk, formerly DO EM residency in the middle of nowhere is soon going to be ACGME accredited. Ah well, its good for a lot of people and I am genuinely happy it is going through, just makes my effort seem a bit wasted is all. Will be interesting to see how it all plays out and I am glad I likely do not have to worry about resolution 42 any longer.

I wouldn't worry about it because I have a feeling that a good bit of DO EM programs will close because they won't be able to meet the ACGME standards.
Also with the AOA track record this could come to a crashing halt prior to implementation....

I personally wonder what this means for speciality boards, will we be able to take the acgme version in addition/instead of the osteo ones ?

 

[scummie]

Never thought Id see it happen, pretty crazy. Good thing I busted my arse to get into a good MD residency and now any podunk, formerly DO EM residency in the middle of nowhere is soon going to be ACGME accredited. Ah well, its good for a lot of people and I am genuinely happy it is going through, just makes my effort seem a bit wasted is all. Will be interesting to see how it all plays out and I am glad I likely do not have to worry about resolution 42 any longer.

Honestly, I'm not sure how many DO residencies would close based on accreditation. I just looked up some of the accreditation standards from the ACGME for residency programs and the only one that stands out so far is on page 11,

"The primary clinical site to which residents rotate must have at least 30,000 emergency department visits annually."

Only one DO EM program, the one in Wheeling, WV has 24K visits per year. I didn't check every single one, just the ones in random places.

Here's the document from the ACGME: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/110_emergency_medicine_07012013.pdf

Where else do you guys think the DO programs would fall short? I think it will force a lot of them to improve their didactics and faculty. Hopefully this means better quality education for everyone.

 

[Makati2008]

Honestly, I'm not sure how many DO residencies would close based on accreditation. I just looked up some of the accreditation standards from the ACGME for residency programs and the only one that stands out so far is on page 11,

"The primary clinical site to which residents rotate must have at least 30,000 emergency department visits annually."

Only one DO EM program, the one in Wheeling, WV has 24K visits per year. I didn't check every single one, just the ones in random places.

Here's the document from the ACGME: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/110_emergency_medicine_07012013.pdf

Where else do you guys think the DO programs would fall short? I think it will force a lot of them to improve their didactics and faculty. Hopefully this means better quality education for everyone.

I agree with you about the didactics and faculty. When I ranked my three osteo places that was very important.

 

[sylvanthus]

I bet only a couple close, some will be forced to improve though which will be good for everyone.

 

[jslo85]

Honestly, I'm not sure how many DO residencies would close based on accreditation. I just looked up some of the accreditation standards from the ACGME for residency programs and the only one that stands out so far is on page 11,

"The primary clinical site to which residents rotate must have at least 30,000 emergency department visits annually."

Only one DO EM program, the one in Wheeling, WV has 24K visits per year. I didn't check every single one, just the ones in random places.

Here's the document from the ACGME: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/110_emergency_medicine_07012013.pdf

Where else do you guys think the DO programs would fall short? I think it will force a lot of them to improve their didactics and faculty. Hopefully this means better quality education for everyone.

Did you see this?

Emergency Medicine 11

III.B.2. There should be a minimum of six residents per year in the program. (Detail)

I can think of more than "one" program to say the least that doesn't fulfill this criteria

 

[DO3]

The are three things that I see that could create issues for DO programs.

1. Programs must have 1 core faculty member for every 3 residents.

2. Residents must have 4 months of critical care rotations, to include the critical care of infants and children. There are a lot of DO programs that don't have a PICU rotation.

3. The minimum of six residents per class as noted above. There are more than of a handful of DO EM programs that don't meet that.

 

[scummie]

The are three things that I see that could create issues for DO programs.

1. Programs must have 1 core faculty member for every 3 residents.

2. Residents must have 4 months of critical care rotations, to include the critical care of infants and children. There are a lot of DO programs that don't have a PICU rotation.

3. The minimum of six residents per class as noted above. There are more than of a handful of DO EM programs that don't meet that.

Well, DO programs have 5 years to get their act together.

Why not just to do an out rotation to address the PICU problem?

I think the biggest issue, which I overlooked, is the 6 residents per year. A lot of DO EM programs are 4-5 per year. How can you expand your residency class with the ACA on the horizon? I'm not an expert on residency funding by any means. Maybe the $1500 per COMLEX PE will have to go towards residency programs.

 

[jslo85]

The are three things that I see that could create issues for DO programs.

1. Programs must have 1 core faculty member for every 3 residents.

2. Residents must have 4 months of critical care rotations, to include the critical care of infants and children. There are a lot of DO programs that don't have a PICU rotation.

3. The minimum of six residents per class as noted above. There are more than of a handful of DO EM programs that don't meet that.

I don't know if 1 is that much of an issue, according to the pdf document, the program director alone qualifies as one core faculty member. If the minimum is 6, then you just really need one more.

As for the 4 months of CC rotations, I see that as being sort of broad. It should include PICU exposure and yes not every DO EM program has rotations with a children's hospital but they do have five years to secure something. This shouldn't be too much of a problem I think given the 5 year time span to set up an affiliation especially if all AOA programs are switching over to ACGME (theoretically). I would think more hospitals would be receptive to this.

The six residents per class.. is going to be far more of an issue. As the poster above pointed out, achieving the minimum ED volume of 30K isn't even a problem for anyone except Wheeling, so would it be possible to expand the residency class size? Or is that more of a funding issue?

 

[DO3]

Well, DO programs have 5 years to get their act together.

Why not just to do an out rotation to address the PICU problem?

When I was interviewing at DO programs that did not have a PICU rotation, I asked that question. Evidently, it's not that easy. There are several DO programs I interviewed at that had tried to put together a PICU rotation for several years with no success.

 

[AD28]

I can actually think of some allopathic programs that don't have 4 dedicated months of critical care time, so I'm guessing that requirement can be met in other ways.

 

[RustedFox]

Guys, there are a lot of ACGME-ressies that dont' have a PICU spot. Its not an easy thing to get. At all. I didn't have one. My "Pedi EM" months were pretty great when it came down to getting the pedi-crit-care exposure.

 

[jslo85]

I mean I get that not everyone can secure a rotation with CHOP or Akron children's for a month or two. But the exact wording was 4 months of critical care, with care of neonatal and infants. I'm reading it as far more of 4 months of critical care SPACE with exposure to the care of pediatric and infants as well somewhere in that. Some programs will have their PICU rotations and peds EM at a children's hospital, others won't. I don't think that part is something to focus on as others above have pointed out that some ACGME residencies lack that as well.

 

[scummie]

I mean I get that not everyone can secure a rotation with CHOP or Akron children's for a month or two. But the exact wording was 4 months of critical care, with care of neonatal and infants. I'm reading it as far more of 4 months of critical care SPACE with exposure to the care of pediatric and infants as well somewhere in that. Some programs will have their PICU rotations and peds EM at a children's hospital, others won't. I don't think that part is something to focus on as others above have pointed out that some ACGME residencies lack that as well.

Right, I agree with you. How do you come up with $90K to pay two extra residents per year?

Also, if most of the programs have to expand by 2 residents, wouldn't that theoretically mean more spots overall in the match?

 

[DO3]

Right, I agree with you. How do you come up with $90K to pay two extra residents per year?

Also, if most of the programs have to expand by 2 residents, wouldn't that theoretically mean more spots overall in the match?

And don't forget...an extra 8-12 residents (2-3 per year depending on the program) means you may have to hire an additional 2-4 attendings to keep the 3-1 faculty-to-resident ratio.

 

[AD28]

If I'm not mistaken, the number of residency spots that a program has is more or less set and funded by CMS if the hospital can prove that it can support the spots. The hospital does have to pick up malpractice for the residents on its own I think, which is a big cost to the hospital.

 

[BoardingDoc]

Stupid question from an MD student: what difference does this make? I don't know much about AOA residency programs vs ACGME ones except for the fact that I can't apply to AOA ones. I gather that going to ACGME programs confers some advantages over AOA programs based on the fact that a lot of DO students talk about trying to get into ACGME residency programs, but I have no idea why.

Anyway, thanks for the info and apologies for the slightly idiotic question.

 

[AD28]

I keeps it real. There are many reasons why DOs pursue ACGME residencies. AOA residencies tend to be in more rural/less desirable locations with less volume. ACGME residencies have better reputations and all the benefits that come with it. Coming from a well known MD program will help secure that job or fellowship you want. Coming from a program in MiddleofNowhere, OK will not make it easier. Superior teaching and pathology is also a big motivator. Having rotated at hospitals with DO residencies and MD residencies, I have found that MD residents receive better teaching from faculty (bedside or otherwise), more structured didactics, and better support from administration.

I think the big issue recently was that the "common program requirements" would have necessitated an ACGME residency in order to pursue ACGME fellowships. There are very few AOA fellowships that we can apply for so our options for subspecialty training are really limited to ACGME fellowships. As long as the unified accreditation system goes into effect, that is no longer an issue and you will be able to cross over from AOA to ACGME fellowships and vice-versa.

 

[red10]

So will some programs still be solely DO even though they have the same training requirements or is this going to ultimately make a larger pool of possible residencies for everyone?

 

[qwerty111]

I actually think this benefits the foreign medical grads and the MD applicants with less than stellar application. It helps with the DO applicant who can't decide between staying in the DO match or going for the MD match. there will still be plenty of programs who will only take MD and there will still be DO programs who mostly take DO out of tradition.

 

[HarryPlopper]

So will some programs still be solely DO even though they have the same training requirements or is this going to ultimately make a larger pool of possible residencies for everyone?

No, all programs should be open to MDs and DOs alike. There will be a larger pool of possible residencies for the individual applicant but there will also be a larger pool of applicants for all residencies as well.

 

[NurWollen]

Is it possible that the ACGME might modify its 6-resident rule or that osteopathic programs that don't meet it might be grandfathered in? I mean, lets say you have a residency with 4 residents per year in a 45,000 visit ED, and another program in an ED with 60, 000 yearly visits and 12 residents per year, wouldn't the former have more volume per resident?

 

[HarryPlopper]

Is it possible that the ACGME might modify its 6-resident rule or that osteopathic programs that don't meet it might be grandfathered in? I mean, lets say you have a residency with 4 residents per year in a 45,000 visit ED, and another program in an ED with 60, 000 yearly visits and 12 residents per year, wouldn't the former have more volume per resident?

Yes it certainly is possible but there is still 5 years. In addition it won't be as if the programs will be sitting on their asses; in order remain competitive with all the other residencies, they will do what they can to meet that quote. If it just isn't feasible, then it seems more likely that there will be accommodations rather than a mass loss of accreditation.

Also about the residents per number of visits, I understand what you are saying but I don't think it's that simple in terms of involvement of the resident with the number of visits. You have to factor in the acuity, resources, the involvement of the attendings and the nurses, and location. I know this doesn't directly answer your question, but these factors affect the quality of education.