163 182 422 - Endovascular Surgical Neuroradiology - 2021 - TCC
163 182 422 - Endovascular Surgical Neuroradiology - 2021 - TCC
163 182 422 - Endovascular Surgical Neuroradiology - 2021 - TCC
164
165 I.D.1.a).(3) The sites where endovascular surgical neuroradiology
166 training is conducted must include appropriate inpatient,
167 outpatient, emergency, and intensive care facilities for
168 direct fellow involvement in providing comprehensive
169 endovascular surgical neuroradiology care. (Core)
170
171 I.D.1.a).(4) The Institution should provide laboratory facilities to
172 support research projects pertinent to endovascular
173 therapies. (Detail)†
174
175 I.D.2. The program, in partnership with its Sponsoring Institution, must
176 ensure healthy and safe learning and working environments that
177 promote fellow well-being and provide for: (Core)
178
179 I.D.2.a) access to food while on duty; (Core)
180
181 I.D.2.b) safe, quiet, clean, and private sleep/rest facilities available
182 and accessible for fellows with proximity appropriate for safe
183 patient care; (Core)
184
Background and Intent: Care of patients within a hospital or health system occurs
continually through the day and night. Such care requires that fellows function at
their peak abilities, which requires the work environment to provide them with the
ability to meet their basic needs within proximity of their clinical responsibilities.
Access to food and rest are examples of these basic needs, which must be met while
fellows are working. Fellows should have access to refrigeration where food may be
stored. Food should be available when fellows are required to be in the hospital
overnight. Rest facilities are necessary, even when overnight call is not required, to
accommodate the fatigued fellow.
185
186 I.D.2.c) clean and private facilities for lactation that have refrigeration
187 capabilities, with proximity appropriate for safe patient care;
(Core)
188
189
Background and Intent: Sites must provide private and clean locations where fellows
may lactate and store the milk within a refrigerator. These locations should be in close
proximity to clinical responsibilities. It would be helpful to have additional support
within these locations that may assist the fellow with the continued care of patients,
such as a computer and a phone. While space is important, the time required for
lactation is also critical for the well-being of the fellow and the fellow's family, as
outlined in VI.C.1.d).(1).
190
191 I.D.2.d) security and safety measures appropriate to the participating
192 site; and, (Core)
193
194 I.D.2.e) accommodations for fellows with disabilities consistent with
195 the Sponsoring Institution’s policy. (Core)
196
451
452 II.B.2.g) pursue faculty development designed to enhance their skills
453 at least annually; (Core)
454
455 II.B.2.h) The physician faculty must provide didactic teaching and direct
456 supervision of fellows' performance in clinical patient management
457 and in the procedural, interpretive, and consultative aspects of
458 endovascular surgical neuroradiology therapy. (Core) [Moved from
459 IV.C.7.]
460
Background and Intent: Faculty development is intended to describe structured
programming developed for the purpose of enhancing transference of knowledge, skill,
and behavior from the educator to the learner. Faculty development may occur in a
variety of configurations (lecture, workshop, etc.) using internal and/or external
resources. Programming is typically needs-based (individual or group) and may be
specific to the institution or the program. Faculty development programming is to be
reported for the fellowship program faculty in the aggregate.
461
462 II.B.3. Faculty Qualifications
463
464 II.B.3.a) Faculty members must have appropriate qualifications in
465 their field and hold appropriate institutional appointments.
(Core)
466
467
468 II.B.3.b) Subspecialty physician faculty members must:
469
470 II.B.3.b).(1) have current certification in the specialty by the
471 American Board of Neurological Surgery, Psychiatry and
472 Neurology, Radiology, or the American Osteopathic
473 Board of Neurological Surgery, Neurology and Psychiatry,
474 Radiology, or possess qualifications judged acceptable
475 to the Review Committee; (Core)
476
495
496 II.B.3.c) Any non-physician faculty members who participate in
497 fellowship program education must be approved by the
498 program director. (Core)
499
Background and Intent: The provision of optimal and safe patient care requires a team
approach. The education of fellows by non-physician educators enables the fellows to
better manage patient care and provides valuable advancement of the fellows’
knowledge. Furthermore, other individuals contribute to the education of the fellow in
the basic science of the subspecialty or in research methodology. If the program
director determines that the contribution of a non-physician individual is significant to
the education of the fellow, the program director may designate the individual as a
program faculty member or a program core faculty member.
500
501 II.B.3.d) Any other specialty physician faculty members must have
502 current certification in their specialty by the appropriate
503 American Board of Medical Specialties (ABMS) member
504 board or American Osteopathic Association (AOA) certifying
505 board, or possess qualifications judged acceptable to the
506 Review Committee. (Core)
507
508 II.B.4. Core Faculty
509
510 Core faculty members must have a significant role in the education
511 and supervision of fellows and must devote a significant portion of
512 their entire effort to fellow education and/or administration, and
513 must, as a component of their activities, teach, evaluate, and provide
514 formative feedback to fellows. (Core)
515
Background and Intent: Core faculty members are critical to the success of fellow
education. They support the program leadership in developing, implementing, and
assessing curriculum and in assessing fellows’ progress toward achievement of
competence in the subspecialty. Core faculty members should be selected for their
The program coordinator is a member of the leadership team and is critical to the success
of the program. As such, the program coordinator must possess skills in leadership and
personnel management. Program coordinators are expected to develop unique knowledge
of the ACGME and Program Requirements, policies, and procedures. Program
coordinators assist the program director in accreditation efforts, educational
programming, and support of fellows.
636
648
649 III.A.1.b).(2).(b).(iv) recognition and management of
650 complication of angiographic procedures;
651 and, (Core)
652
653 III.A.1.b).(2).(b).(v) understanding the fundamentals of non-
654 invasive neurovascular imaging studies
655 pertinent to the practice of endovascular
656 surgical neuroradiology, including CT/CTA,
657 MR/MRA, and sonography of neurovascular
658 diseases. (Core)
659
660 III.A.1.b).(3) Fellows entering from neurology should have:
661
662 III.A.1.b).(3).(a) completed an ACGME-, AOA-, ACGME-I-
663 accredited residency in child neurology or
664 neurology or an RCPSC-accredited residency in
665 child neurology or neurology located in Canada;
666 (Core)
667
668 III.A.1.b).(3).(b) completed an ACGME-, AOA-, ACGME-I-
669 accredited one-year vascular/stroke neurology
670 program or an RCPSC-accredited one-year
671 vascular/stroke neurology program located in
672 Canada that includes at least three months of
673 neuro-intensive care; (Core)
674
675 III.A.1.b).(3).(c) completed three months of clinical experience
676 within an ACGME-, AOA-, ACGME-I-accredited
677 neurological surgery program or an RCPSC-
678 accredited neurological surgery program located in
679 Canada; (Core)
680
681 III.A.1.b).(3).(d) completed a preparatory year of neuroradiology
682 training, which provides education and clinical
683 experience that includes: (Core)
684
685 III.A.1.b).(3).(d).(i) a course in basic radiographic skills,
686 including radiation physics, radiation
687 biology, and radiation protection; and the
692
693 III.A.1.b).(3).(d).(ii) performing and interpreting a minimum of
694 100 diagnostic neuroangiograms under the
695 supervision of a qualified physician (Board-
696 certified neuroradiologist, interventional
697 neuroradiologist, endovascular
698 neurosurgeon, or intervening neurologist
699 with appropriate training); (Core)
700
701 III.A.1.b).(3).(d).(iii) instruction in the use of needles, catheters,
702 guidewires, and angiographic devices and
703 materials; (Core)
704
705 III.A.1.b).(3).(d).(iv) recognition and management of
706 complication of angiographic procedures;
707 and, (Core)
708
709 III.A.1.b).(3).(d).(v) understanding the fundamentals of non-
710 invasive neurovascular imaging studies
711 pertinent to the practice of endovascular
712 surgical neuroradiology, including CT/CTA,
713 MR/MRA and sonography of neurovascular
714 diseases. (Core)
715
716 III.A.1.c) Fellow Eligibility Exception
717
718 The Review Committee for Radiology will allow the following
719 exception to the fellowship eligibility requirements:
720
721 III.A.1.c).(1) An ACGME-accredited fellowship program may accept
722 an exceptionally qualified international graduate
723 applicant who does not satisfy the eligibility
724 requirements listed in III.A.1., but who does meet all of
725 the following additional qualifications and conditions:
(Core)
726
727
728 III.A.1.c).(1).(a) evaluation by the program director and
729 fellowship selection committee of the
730 applicant’s suitability to enter the program,
731 based on prior training and review of the
732 summative evaluations of training in the core
733 specialty; and, (Core)
734
735 III.A.1.c).(1).(b) review and approval of the applicant’s
736 exceptional qualifications by the GMEC; and,
(Core)
737
738
In recognition of the diversity of medical education and training around the world, this
early evaluation of clinical competence required for these applicants ensures they can
provide quality and safe patient care. Any gaps in competence should be addressed
as per policies for fellows already established by the program in partnership with the
Sponsoring Institution.
748
749 III.B. The program director must not appoint more fellows than approved by the
750 Review Committee. (Core)
751
752 III.B.1. All complement increases must be approved by the Review
753 Committee. (Core)
754
755 III.C. Fellow Transfers
756
757 The program must obtain verification of previous educational experiences
758 and a summative competency-based performance evaluation prior to
759 acceptance of a transferring fellow, and Milestones evaluations upon
760 matriculation. (Core)
761
762 IV. Educational Program
763
764 The ACGME accreditation system is designed to encourage excellence and
765 innovation in graduate medical education regardless of the organizational
766 affiliation, size, or location of the program.
767
768 The educational program must support the development of knowledgeable, skillful
769 physicians who provide compassionate care.
770
771 In addition, the program is expected to define its specific program aims consistent
772 with the overall mission of its Sponsoring Institution, the needs of the community
773 it serves and that its graduates will serve, and the distinctive capabilities of
These organizing principles inform the Common Program Requirements across all
Competency domains. Specific content is determined by the Review Committees with
input from the appropriate professional societies, certifying boards, and the community.
822
823 IV.B.1.b).(1) Fellows must be able to provide patient care that is
824 compassionate, appropriate, and effective for the
825 treatment of health problems and the promotion of
826 health. (Core)
827
828 IV.B.1.b).(1).(a) Fellows must demonstrate competence as
829 consultants under the supervision of staff
830 endovascular surgical neuroradiology practitioners.
831 (Core)
832
833 IV.B.1.b).(2) Fellows must be able to perform all medical,
834 diagnostic, and surgical procedures considered
835 essential for the area of practice. (Core)
836
837 IV.B.1.b).(2).(a) Fellows must participate in and demonstrate
838 competence in:
839
840 IV.B.1.b).(2).(a).(i) personally performing and analyzing a
841 broad spectrum of endovascular
842 procedures; (Core)
843
The intention of this Competency is to help a fellow refine the habits of mind required
to continuously pursue quality improvement, well past the completion of fellowship.
1013
1014 IV.B.1.e) Interpersonal and Communication Skills
1015
1016 Fellows must demonstrate interpersonal and communication
1017 skills that result in the effective exchange of information and
1018 collaboration with patients, their families, and health
1019 professionals. (Core)
1020
1021 IV.B.1.f) Systems-based Practice
1022
1023 Fellows must demonstrate an awareness of and
1024 responsiveness to the larger context and system of health
1025 care, including the social determinants of health, as well as
1026 the ability to call effectively on other resources to provide
1027 optimal health care. (Core)
1028
1029 IV.C. Curriculum Organization and Fellow Experiences
1030
1031 IV.C.1. The curriculum must be structured to optimize fellow educational
1032 experiences, the length of these experiences, and supervisory
1033 continuity. (Core)
1034
1035 IV.C.1.a) The assignment of educational experiences should be structured
1036 to minimize the frequency of transitions. (Detail)
1037
1038 IV.C.1.b) Educational experiences should be of sufficient length to provide a
1039 quality educational experience defined by ongoing supervision,
1096
1097 IV.C.4.a).(6) Teaching conferences must cover the full extent of
1098 endovascular surgical neuroradiology, including the use of
1099 minimally invasive catheter-based technology, radiologic
1100 imaging, and clinical expertise to diagnose and treat
1101 diseases of the CNS, head, neck, and spine. (Core)
1102
1103 IV.C.4.a).(7) Conference formats should allow for interactive discussion
1104 of the selected topics. (Detail)
1105
1106 IV.C.4.b) Fellows must attend and participate in conferences. (Core)
1107
1108 IV.C.4.b).(1) Protected didactic and interactive conference time must be
1109 provided, including for interdepartmental meetings with
1110 neurosurgeons, neuroradiologists, and neurologists. (Core)
1111
1112 IV.C.4.b).(2) Each fellow should attend and actively participate in
1113 interdepartmental meetings and conferences with child
1114 neurology or neurology, neurological surgery,
1115 neuropathology, and neuroradiology, neurological surgery,
1116 child neurology or neurology, and neuropathology. (Detail)
1117
1118 IV.C.4.b).(2).(a) The program must ensure that regular review of all
1119 mortality and morbidity related to the performance
1120 of endovascular surgical neuroradiology
1121 procedures are documented. Fellows must
1122 participate actively in these reviews, which should
1123 be held at least monthly. (Core)
1124
1125 IV.C.4.b).(2).(b) Fellows should be encouraged to attend and
1126 participate in local extramural conferences and
1127 should attend at least one national meeting or
1128 postgraduate course in endovascular surgical
1129 neuroradiology therapy while in training. (Detail)
1130
Subspecialty-Specific Background and Intent: The Review Committee values the
contributions of extramural education toward enhancing fellows’ overall educational
experience. Fellow attendance and participation in local extramural conferences or national
meetings, or post-graduate coursework in endovascular surgical neuroradiology therapy
during the program is encouraged.
1131
1132 IV.C.5. The program must include training and experience in the following:
1133
1137
1138 IV.C.5.b) physical examinations to evaluate patients with neurological
1139 disorders; (Core)
1140
1141 IV.C.5.c) pathophysiology and natural history of these disorders; (Core)
1142
1143 IV.C.5.d) indications for and contraindications to endovascular surgical
1144 neuroradiology procedures; (Core)
1145
1146 IV.C.5.e) clinical and technical aspects of endovascular surgical
1147 neuroradiology procedures; (Core)
1148
1149 IV.C.5.f) medical and surgical alternatives; (Core)
1150
1151 IV.C.5.g) preoperative and postoperative management of endovascular
1152 patients; (Core)
1153
1154 IV.C.5.h) neurointensive care management; (Core)
1155
1156 IV.C.5.i) fundamentals of imaging physics and radiation biology; and, (Core)
1157
1158 IV.C.5.j) interpretation of neuroangiographic studies pertinent to the
1159 practice. (Core)
1160
1161 IV.C.6. The physician faculty must provide didactic teaching and direct
1162 supervision of fellows' performance in clinical patient management and in
1163 the procedural, interpretive, and consultative aspects of endovascular
1164 surgical neuroradiology therapy. (Core)
1165
1166 IV.C.6.a) Fellows must attend and participate in clinical conferences. (Core)
1167
1168 IV.C.6.b) Fellows must have experience in didactic and clinical experiences
1169 that encompass the full clinical spectrum of endovascular surgical
1170 neuroradiology therapy. (Core)
1171
1172 IV.C.6.c) Fellows must participate in make daily rounds with the
1173 endovascular surgical neuroradiology faculty members during
1174 which patient management decisions are discussed and made.
1175 (Core)
1176
1177 IV.C.6.d) Fellows must have adequate training and experience in invasive
1178 functional testing. (Detail)
1179
1180 IV.C.6.e) Direct supervision interactions of fellows interactions with patients
1181 must be closely observed to ensured so that appropriate
1182 standards of care and concern for patient welfare are strictly
1183 maintained. (Core)
1184
1294
1295 V.A.1.a).(2).(a) Fellows will be advanced to positions of higher
1296 responsibility only on evidence of their satisfactory
1297 progressive scholarship and professional growth.
1298 (Detail)
Fellows who are experiencing difficulties with achieving progress along the Milestones
may require intervention to address specific deficiencies. Such intervention,
documented in an individual remediation plan developed by the program director or a
faculty mentor and the fellow, will take a variety of forms based on the specific learning
needs of the fellow. However, the ACGME recognizes that there are situations which
require more significant intervention that may alter the time course of fellow
progression. To ensure due process, it is essential that the program director follow
institutional policies and procedures.
1356
1357 V.A.1.e) At least annually, there must be a summative evaluation of
1358 each fellow that includes their readiness to progress to the
1359 next year of the program, if applicable. (Core)
1360
1361 V.A.1.f) The evaluations of a fellow’s performance must be accessible
1362 for review by the fellow. (Core)
1363
1364 V.A.2. Final Evaluation
1365
1366 V.A.2.a) The program director must provide a final evaluation for each
1367 fellow upon completion of the program. (Core)
1546
1547 V.C.3.b) For subspecialties in which the ABMS member board and/or
1548 AOA certifying board offer(s) a biennial written exam, in the
1549 preceding six years, the program’s aggregate pass rate of
1550 those taking the examination for the first time must be higher
1551 than the bottom fifth percentile of programs in that
1552 subspecialty.
(Outcome)
1553
1554 V.C.3.c) For subspecialties in which the ABMS member board and/or
1555 AOA certifying board offer(s) an annual oral exam, in the
1556 preceding three years, the program’s aggregate pass rate of
1557 those taking the examination for the first time must be higher
1558 than the bottom fifth percentile of programs in that
1559 subspecialty. (Outcome)
1560
1561 V.C.3.d) For subspecialties in which the ABMS member board and/or
1562 AOA certifying board offer(s) a biennial oral exam, in the
1563 preceding six years, the program’s aggregate pass rate of
1564 those taking the examination for the first time must be higher
1565 than the bottom fifth percentile of programs in that
1566 subspecialty.
(Outcome)
1567
1568 V.C.3.e) For each of the exams referenced in V.C.3.a)-d), any program
1569 whose graduates over the time period specified in the
1570 requirement have achieved an 80 percent pass rate will have
1571 met this requirement, no matter the percentile rank of the
1572 program for pass rate in that subspecialty.
(Outcome)
1573
Background and Intent: Setting a single standard for pass rate that works across
subspecialties is not supportable based on the heterogeneity of the psychometrics of
different examinations. By using a percentile rank, the performance of the lower five
There are subspecialties where there is a very high board pass rate that could leave
successful programs in the bottom five percent (fifth percentile) despite admirable
performance. These high-performing programs should not be cited, and V.C.3.e) is
designed to address this.
1574
1575 V.C.3.f) Programs must report, in ADS, board certification status
1576 annually for the cohort of board-eligible fellows that
1577 graduated seven years earlier. (Core)
1578
Background and Intent: It is essential that fellowship programs demonstrate
knowledge and skill transfer to their fellows. One measure of that is the qualifying or
initial certification exam pass rate. Another important parameter of the success of the
program is the ultimate board certification rate of its graduates. Graduates are eligible
for up to seven years from fellowship graduation for initial certification. The ACGME
will calculate a rolling three-year average of the ultimate board certification rate at
seven years post-graduation, and the Review Committees will monitor it.
The Review Committees will track the rolling seven-year certification rate as an
indicator of program quality. Programs are encouraged to monitor their graduates’
performance on board certification examinations.
In the future, the ACGME may establish parameters related to ultimate board
certification rates.
1579
1580 VI. The Learning and Working Environment
1581
1582 Fellowship education must occur in the context of a learning and working
1583 environment that emphasizes the following principles:
1584
1585 • Excellence in the safety and quality of care rendered to patients by fellows
1586 today
1587
1588 • Excellence in the safety and quality of care rendered to patients by today’s
1589 fellows in their future practice
1590
1591 • Excellence in professionalism through faculty modeling of:
1592
1593 o the effacement of self-interest in a humanistic environment that supports
1594 the professional development of physicians
1595
1596 o the joy of curiosity, problem-solving, intellectual rigor, and discovery
1597
1598 • Commitment to the well-being of the students, residents, fellows, faculty
1599 members, and all members of the health care team
1600
Background and Intent: The revised requirements are intended to provide greater
flexibility within an established framework, allowing programs and fellows more
Clinical and educational work hours represent only one part of the larger issue of
conditions of the learning and working environment, and Section VI has now been
expanded to include greater attention to patient safety and fellow and faculty member
well-being. The requirements are intended to support programs and fellows as they
strive for excellence, while also ensuring ethical, humanistic training. Ensuring that
flexibility is used in an appropriate manner is a shared responsibility of the program and
fellows. With this flexibility comes a responsibility for fellows and faculty members to
recognize the need to hand off care of a patient to another provider when a fellow is too
fatigued to provide safe, high quality care and for programs to ensure that fellows
remain within the 80-hour maximum weekly limit.
1601
1602 VI.A. Patient Safety, Quality Improvement, Supervision, and Accountability
1603
1604 VI.A.1. Patient Safety and Quality Improvement
1605
1606 All physicians share responsibility for promoting patient safety and
1607 enhancing quality of patient care. Graduate medical education must
1608 prepare fellows to provide the highest level of clinical care with
1609 continuous focus on the safety, individual needs, and humanity of
1610 their patients. It is the right of each patient to be cared for by fellows
1611 who are appropriately supervised; possess the requisite knowledge,
1612 skills, and abilities; understand the limits of their knowledge and
1613 experience; and seek assistance as required to provide optimal
1614 patient care.
1615
1616 Fellows must demonstrate the ability to analyze the care they
1617 provide, understand their roles within health care teams, and play an
1618 active role in system improvement processes. Graduating fellows
1619 will apply these skills to critique their future unsupervised practice
1620 and effect quality improvement measures.
1621
1622 It is necessary for fellows and faculty members to consistently work
1623 in a well-coordinated manner with other health care professionals to
1624 achieve organizational patient safety goals.
1625
1626 VI.A.1.a) Patient Safety
1627
1628 VI.A.1.a).(1) Culture of Safety
1629
As these efforts evolve, information will be shared with programs seeking to develop
and/or strengthen their own well-being initiatives. In addition, there are many activities
that programs can utilize now to assess and support physician well-being. These
include culture of safety surveys, ensuring the availability of counseling services, and
attention to the safety of the entire health care team.
1970
1971 VI.C.1. The responsibility of the program, in partnership with the
1972 Sponsoring Institution, to address well-being must include:
1973
1974 VI.C.1.a) efforts to enhance the meaning that each fellow finds in the
1975 experience of being a physician, including protecting time
1976 with patients, minimizing non-physician obligations,
1977 providing administrative support, promoting progressive
1978 autonomy and flexibility, and enhancing professional
1979 relationships; (Core)
The reference to affordable counseling is intended to require that financial cost not be a
barrier to obtaining care.
2027
2028 VI.C.2. There are circumstances in which fellows may be unable to attend
2029 work, including but not limited to fatigue, illness, family
2030 emergencies, and parental leave. Each program must allow an
2031 appropriate length of absence for fellows unable to perform their
2032 patient care responsibilities. (Core)
2033
2034 VI.C.2.a) The program must have policies and procedures in place to
2035 ensure coverage of patient care. (Core)
This requirement emphasizes the importance of adequate rest before and after clinical
responsibilities. Strategies that may be used include, but are not limited to, strategic
napping; the judicious use of caffeine; availability of other caregivers; time management
to maximize sleep off-duty; learning to recognize the signs of fatigue, and self-
monitoring performance and/or asking others to monitor performance; remaining active
to promote alertness; maintaining a healthy diet; using relaxation techniques to fall
asleep; maintaining a consistent sleep routine; exercising regularly; increasing sleep
time before and after call; and ensuring sufficient sleep recovery periods.
2056
2057 VI.D.2. Each program must ensure continuity of patient care, consistent
2058 with the program’s policies and procedures referenced in VI.C.2–
2059 VI.C.2.b), in the event that a fellow may be unable to perform their
2060 patient care responsibilities due to excessive fatigue. (Core)
2061
2062 VI.D.3. The program, in partnership with its Sponsoring Institution, must
2063 ensure adequate sleep facilities and safe transportation options for
2064 fellows who may be too fatigued to safely return home. (Core)
2065
2066 VI.E. Clinical Responsibilities, Teamwork, and Transitions of Care
2067
Scheduling
While the ACGME acknowledges that, on rare occasions, a fellow may work in excess of
80 hours in a given week, all programs and fellows utilizing this flexibility will be
required to adhere to the 80-hour maximum weekly limit when averaged over a four-
week period. Programs that regularly schedule fellows to work 80 hours per week and
still permit fellows to remain beyond their scheduled work period are likely to exceed
the 80-hour maximum, which would not be in substantial compliance with the
requirement. These programs should adjust schedules so that fellows are scheduled to
work fewer than 80 hours per week, which would allow fellows to remain beyond their
scheduled work period when needed without violating the 80-hour requirement.
Programs may wish to consider using night float and/or making adjustments to the
frequency of in-house call to ensure compliance with the 80-hour maximum weekly limit.
Oversight
With increased flexibility introduced into the Requirements, programs permitting this
flexibility will need to account for the potential for fellows to remain beyond their
assigned work periods when developing schedules, to avoid exceeding the 80-hour
maximum weekly limit, averaged over four weeks. The ACGME Review Committees will
strictly monitor and enforce compliance with the 80-hour requirement. Where violations
of the 80-hour requirement are identified, programs will be subject to citation and at risk
for an adverse accreditation action.
During the public comment period many individuals raised questions and concerns
related to this change. Some questioned whether minute by minute tracking would be
required; in other words, if a fellow spends three minutes on a phone call and then a few
hours later spends two minutes on another call, will the fellow need to report that time.
Others raised concerns related to the ability of programs and institutions to verify the
accuracy of the information reported by fellows. The new requirements are not an
attempt to micromanage this process. Fellows are to track the time they spend on
clinical work from home and to report that time to the program. Decisions regarding
whether to report infrequent phone calls of very short duration will be left to the
individual fellow. Programs will need to factor in time fellows are spending on clinical
work at home when schedules are developed to ensure that fellows are not working in
excess of 80 hours per week, averaged over four weeks. There is no requirement that
programs assume responsibility for documenting this time. Rather, the program’s
responsibility is ensuring that fellows report their time from home and that schedules
are structured to ensure that fellows are not working in excess of 80 hours per week,
averaged over four weeks.
2123
2124 VI.F.2. Mandatory Time Free of Clinical Work and Education
2125
2126 VI.F.2.a) The program must design an effective program structure that
2127 is configured to provide fellows with educational
2128 opportunities, as well as reasonable opportunities for rest
2129 and personal well-being. (Core)
2130
2131 VI.F.2.b) Fellows should have eight hours off between scheduled
2132 clinical work and education periods. (Detail)
2133
2134 VI.F.2.b).(1) There may be circumstances when fellows choose to
2135 stay to care for their patients or return to the hospital
2136 with fewer than eight hours free of clinical experience
2137 and education. This must occur within the context of
2138 the 80-hour and the one-day-off-in-seven
2139 requirements. (Detail)
2140
In their evaluation of fellowship programs, Review Committees will look at the overall
impact of at-home call on fellow rest and personal time.
2239
2240 ***
2241 *Core Requirements: Statements that define structure, resource, or process elements
2242 essential to every graduate medical educational program.
2243
2244 †
Detail Requirements: Statements that describe a specific structure, resource, or process, for
2245 achieving compliance with a Core Requirement. Programs and sponsoring institutions in
2246 substantial compliance with the Outcome Requirements may utilize alternative or innovative
2247 approaches to meet Core Requirements.
2248
2249 ‡
Outcome Requirements: Statements that specify expected measurable or observable
2250 attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their
2251 graduate medical education.
2252
2253 Osteopathic Recognition
2254 For programs with or applying for Osteopathic Recognition, the Osteopathic Recognition
2255 Requirements also apply (www.acgme.org/OsteopathicRecognition).