As the resident representative to ACGME’s Review Committee for Emergency Medicine, it is my pleasure and honor to provide an RC-EM update to EMRA and the readers of EM Resident magazine.
Please read on for updates in key areas affecting emergency medicine residents:
- Hospital closures
- Parental leave
- Diversity in medicine
- Single Accreditation System
- Faculty protected time
- COVID-19
Hospital Closures
Excluding the global pandemic, the most well-known issue in graduate medical education over the past year was the sudden closure of Hahnemann University Hospital in the summer of 2019.1 A total of 553 residents and fellows from 35 programs were affected by this abrupt announcement, including 55 residents and fellows on J-1 visas.1
The response from the medical community was overwhelming and supportive; the ACGME, AMA, AOA, AAMC, ECFMG, NRMP, FSMB, ABMS, and many other medical organizations came together to support the trainees affected. 1 A total of 1,530 available positions were offered to the displaced trainees, representing a total of 190 sponsoring institutions in 39 states.1
Ultimately, 100% of the displaced residents and fellows transferred to new programs, and 60% were able to stay in the Philadelphia metro area.1 Hahnemann University Hospital declared bankruptcy in addition to closing the hospital, which left 1,400+ trainees and alumni without medical liability “tail” coverage.2 A $9.3 million settlement was reached in March 2020, ensuring liability coverage for Hahnemann residents, fellows, and alumni.3
Ohio Valley Medical Center’s hospital closure was announced in August 2019.1 All 15 internal medicine and 17 emergency medicine residents were able to transfer to other training programs, and a total of 325 positions were offered to the displaced residents.1 This closure was different than Hahnemann’s because Ohio Valley Medical Center did not declare bankruptcy, therefore tail coverage was provided to these residents.1
The February 2020 ACGME Annual Educational Conference included excellent discussion and recognition of the lessons learned from these events and plans for how to be better prepared for future hospital closures.1
Parental Leave
Parental/family leave is a topic that has gained a lot of attention in recent months, thanks to the advocacy of the ACGME’s Council of Review Committee Residents.4 In the fall of 2019, the ACGME created a multi-disciplinary task force dedicated to this topic. Parental/family leave is a multifaceted issue that has ramifications for board eligibility, which is why the task force includes direct collaboration with the American Board of Medical Specialties (ABMS).4
"This work will lead to a more standardized approach to parental leave policies for resident and fellow parents by certifying boards, accreditation requirements, Sponsoring Institutions, and programs."4
Final recommendations are expected in 2020.
Diversity
Diversity is an important topic at the ACGME. The revised common program requirements that went into effect in July 2019 included a new core requirement, item I.C., that codifies diversity in graduate medical education.
"The program, in partnership with its Sponsoring Institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative staff members, and other relevant members of its academic community."5
The ACGME hired William A. McDade, MD, PhD, as its first Chief Diversity and Inclusion Officer in March 2019.6 Dr. McDade comes to the ACGME from Ochsner Health System in New Orleans, where he was executive vice president and chief academic officer. Prior to his appointment at Ochsner, Dr. McDade was a professor of anesthesia and critical care at the University of Chicago.
On Feb. 20, 2020, the ACGME announced Bonnie Mason, MD, as the Vice President of Diversity and Inclusion.7 Prior to joining the ACGME, Dr. Mason was the founder and executive director of Nth Dimensions. She is also the co-founder/chief executive officer of Beyond the Exam Room, where she has developed a comprehensive, continuing medical education (CME)-accredited business of medicine, career development, leadership, and financial curriculum for young physicians at the undergraduate and graduate medical education levels.
Single Accreditation System
The single accreditation system will conclude its 5-year transition this year. After the completion of the transition, all GME programs in the United States will be accredited by the ACGME.8 This brought unique changes to the GME landscape, including a single match through the National Resident Matching Program (NRMP).8
All GME programs can apply for osteopathic recognition, which provides osteopathic training in graduate medical education.8
As of March 2020, 89% of the 62 previously AOA-accredited emergency medicine programs have an accreditation status with the ACGME; 28 programs are on continued accreditation, 23 on initial accreditation, 4 on initial accreditation with warning, 1 had accreditation withdrawn, and 6 closed.8
Faculty Protected Time
In the 2019 July revised common program requirements, the stipulation regarding core faculty protected time was removed. The subsequent outcry from the emergency medicine9 and family medicine communities inspired the ACGME to create a task force dedicated to this issue.
The task force recommended including language that protects core faculty non-clinical time which prompted the emergency medicine review committee to add language to this effect.10
The open comment period for the proposed language closed March 25.11 If approved by the ACGME Board of Directors, the new language will take effect July 2020.
COVID-19
These are unprecedented times. The ACGME has suspended several accreditation-related activities to allow for the prioritization of patient care, including self-study activities, accreditation site visits, CLER program site visits, and resident, fellow and faculty surveys.12
Additionally, the telemedicine supervision requirements that were scheduled to go in to effect in July of 2020 were fast tracked to help the medical community respond to the pandemic.13 The ACGME president and CEO noted in March that 3 areas of priority include maintenance of duty hour requirements, adequate resources and training related to COVID-19, and adequate supervision for residents and fellows.13
This is a constantly evolving situation; please check the ACGME’s Newsroom online for the latest updates.
References
- Johnson PF, Weiss K, Pinsky W, Orlowski J, Skochelak S, Chaudhry H, Nasca TJ, Wallowicz T. SES071: Looking back at the closure of Hahnemann University Hospital [Conference session]. ACGME Annual Education Conference. Feb. 28, 2020; Conference conducted at the meeting of the ACGME in San Diego, CA.
- O'Reilly K. AMA-brokered deal secures coverage for Hahnemann residents, fellows. AMA. March 3, 2020.
- Harris P. Coverage secured for displaced Hahnemann residents and fellows [e-mail communication]. March 9, 2020.
- Rialon K, Bienstock J, Combes J, Kinney C, Schleiter K. SES126: Fostering professional equity: Parental leave in GME [Conference session]. ACGME Annual Education Conference. 29, 2020; Conference conducted at the meeting of the ACGME in San Diego, CA.
- Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements (Residency). July 1, 2019.
- Accreditation Council for Graduate Medical Education. ACGME names first chief diversity and inclusion officer. ACGME Newsroom. March 11, 2019.
- Accreditation Council for Graduate Medical Education. Bonnie Mason, MD joins the ACGME as Vice President, Diversity and Inclusion. ACGME Newsroom. Feb. 20, 2020.
- Zabbo C. Updates from AOBEM on board certification [Conference session]. CORD Academic Assembly. March 10, 2020; Conference conducted at the meeting of CORD in New York City, NY.
- Beaulieu A, Eales T, Sanchez K, Aintablian H, Nikolla D, Naik N. Emergency medicine residents oppose ACGME changes to the Common Program Requirements. EM Resident. 2019;46(4):6-7.
10. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine: Summary and impact of focused requirement revisions. 2020.
11. Accreditation Council for Graduate Medical Education. (n.d.). Review and comment.
12. Accreditation Council for Graduate Medical Education. ACGME response to the Coronavirus (COVID-19). ACGME Newsroom. March 18, 2020.