(Archived) Stage 2: Increased Clinical Demands Guidance
Sponsoring Institutions and programs remain responsible for upholding ACGME requirements to ensure patient safety and resident/fellow safety and well-being. Some residents/fellows may shift to patient care duties associated with the pandemic, and/or some educational activities may be suspended.
The Common Program Requirements, specialty-specific Program Requirements, and Institutional Requirements remain in effect with flexibility as outlined in the Frequently Asked Questions.
The ACGME Review Committees will focus on programs’ adherence to requirements addressing resident/fellow safety, supervision, and work hours as follows:
1. Adequate Resources and Training
All residents/fellows must be trained in, and be provided with, appropriate infection protection for the clinical setting and situation. Appropriateness should consider the needs of the patient and the health care team, as well as the range of clinical care services being provided. Residents/fellows must only be assigned to participating sites that ensure the safety of patients and residents/fellows.
2. Adequate Supervision
Any resident/fellow who provides care to patients will do so under appropriate supervision for the clinical circumstance and for the level of education and experience of the resident/fellow. Faculty members are expected to have been trained in the treatment and infection control protocols and procedures adopted by their local health care settings.
3. Work Hour Requirements
The ACGME Common Program Requirements in Section VI.F. addressing work hours remain unchanged. Safety of patients and residents/fellows is the ACGME’s highest priority, and it is vital all residents and fellows receive adequate rest between clinical duties. Violations of the work hour limitations have been associated with an increase in medical errors, needle sticks, and other adverse events that might lead to lapses in infection control. Deviations in this domain could increase risks for both patients and residents/fellows.
4. Fellows Functioning in Core Specialty
Fellows in ACGME-accredited programs can function within their core specialty, consistent with the policies and procedures of the Sponsoring Institution and its participating sites, if:
- they are American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board-eligible or -certified in the core specialty;
- they are appointed to the medical staff at the Sponsoring Institution; and,
- their time spent on their core specialty service is limited to 20 percent of their annual education time in any academic year.
Additionally, professionalism is one of the six Core Competencies that must be manifested by all physicians. This includes arriving fit for duty, practicing at the appropriate level of competence with appropriate supervision, and training physicians to care for patients and the public without causing harm to themselves and those they care for. Because of this, the ACGME will still expect Sponsoring Institutions and programs to maintain strict compliance to the work hour, supervision, and safety requirements, and will be working to determine appropriate mechanisms to monitor adherence in these important areas.