Major changes are coming to the nation’s medical residency programs. The Accreditation Council for Graduate Medical Education (ACGME), the nonprofit organization that evaluates and accredits more than 9,000 medical residency programs in the United States, has announced it will transform how these programs will be accredited in the years ahead.

As described in an article in The New England Journal of Medicine (2012;366:1051-1056), the ACGME’s next accreditation system (NAS) for graduate medical education is centered on six domains of clinical competency, developed in concert with the American Board of Medical Specialties. In an interview, the article’s lead author, Thomas J. Nasca, MD, MACP, chief executive officer of the ACGME in Chicago, characterized these domains as “patient care and technical skills; medical knowledge; professionalism; interpersonal communication; systems-based practices; and practice-based learning and improvement.” Dr. Nasca stated that the NAS “is the culmination of a decade’s worth of work building consensus around the competencies.”

The difference between the past accreditation system and the NAS, said Dr. Nasca, is that the new system will evaluate educational outcomes rather than just process, and the core or essential educational outcomes will be standardized for each specialty. To distinguish between a process standard and an outcome standard, Dr. Nasca gave the following example: “There must be simulation training in induction of anesthesia” is a process standard; “The resident demonstrates effective incorporation of knowledge and skill in the administration of anesthesia” is an outcome standard.

In July 2013, seven of the 26 ACGME-accredited core specialties will implement the NAS. The seven specialties are emergency medicine, internal medicine, neurologic surgery, orthopedic surgery, pediatrics, diagnostic radiology and urology. In July 2014, the remaining specialties will apply the NAS.

Dr. Nasca detailed some of the projected benefits of the NAS. Residents will be reassured that all programs teach and evaluate the same desired outcomes, with a “more targeted evaluation of performance, and more effective formative feedback—a focus on what is essential.” The program directors will get a less intrusive ACGME, with decreased administrative burden, giving them time for more mentoring and direct education. The public will be the “ultimate beneficiary,” because it will get better-trained physicians.

“It’s not just an educational exercise,” said Dr. Nasca. “We will reassure the public of the completeness of the training and that each graduate has demonstrated the core skills required in their chosen specialty, prior to entering clinical practice in the profession.”

According to Christine Stencel, spokesperson at the Institute of Medicine (IOM), the National Academies, Washington, D.C., “The new accreditation system is consistent with recommendations of the IOM’s 2003 report Health Professions Education: A Bridge to Quality.” However, when asked about the IOM’s view of the NAS, Ms. Stencel pointed to a study of the governance and financing of graduate medical education that the IOM will begin conducting in June 2012. “The committee for that study will likely take up aspects of the ACGME accreditation reported by Dr. Nasca in The New England Journal of Medicine. IOM cannot prognosticate on what this related new study will conclude and recommend and therefore must withhold any judgments.”



Dr. Nasca and Ms. Stencel reported no relevant financial disclosures.