The following article is adapted from “ACGME International: The First 10 Years,” which was recently published in the Journal of Graduate Medical Education
’s International Supplement. The article, written by Susan H. Day, MD, senior vice president, Medical Affairs, ACGME International; and Thomas J. Nasca, MD, MACP, president and chief executive officer, Accreditation Council for Graduate Medical Education and ACGME International, can be read along with other articles about the state of post-graduate medical education globally, at jgme.org.
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In 2008, a request was made by the Ministry of Health in Singapore. It sought a transformational change in its graduate medical education (GME) program in order to reliably produce physicians, in greater numbers, more capable of serving Singapore’s needs… The ACGME was petitioned to provide accreditation services and parallel educational programs to transform the postgraduate system. A pilot project was formulated and approved in 2009 by the ACGME Board of Directors in response to this request.
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ACGME International (ACGME-I) modeled the international standards in a framework similar to those used in the United States. Of paramount importance was the insistence that institutional accreditation was an essential first step. For program accreditation, a fundamental difference was to create a two-step process of foundational and advanced specialty accreditation. Foundational Requirements provide an educational framework similar to the ACGME Common Program Requirements. Advanced Specialty Requirements govern unique aspects of a specialty. In order to ensure implementation of the educational framework, Foundational Accreditation must be granted prior to consideration for Advanced Specialty Accreditation. This two-step process could be completed at the same time, but Advanced Specialty Accreditation is not considered unless the foundational application demonstrated substantial compliance.
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The success of the pilot program in Singapore resulted in additional requests for accreditation services… As new requests for accreditation services and expanded educational outreach occurred, so too did an expansion of ACGME-I standard-setting responsibilities. In provision of accreditation services to expanded areas in different cultures and systems of health care delivery, it became apparent that these differences had two important lessons: one, standards had to be relevant to the jurisdiction where they were being applied, and two, a supportive, accredited clinical learning environment is crucial for successful programmatic accreditation. For the first lesson, this imperative to create flexibility centers on cultural, scope of practice, and societal needs as illustrated in the following examples. In some countries, physicians’ work hours—regardless of stature or specialty—are curtailed at 35 hours, various specialists perform thyroidectomies, and age demographics influence availability of clinical experience as well as scope of practice for various specialties.
This focused effort has resulted in a gradual evolution toward truly international requirements, which should also be compliant with the postgraduate medical education accreditation framework proposed by the World Federation for Medical Education. In the second lesson, it is vital that the ACGME-I requirements continue to emphasize a supportive clinical learning environment with institutional accreditation required prior to any programmatic approval. Oversight of education by institutions has significant variation across the world, and ACGME-I’s requirements have led to a more standardized approach centered on patient care and commitment to education.
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As of July 2019, ACGME-I accredits 15 Sponsoring Institutions, and approximately 150 programs. There are 4,022 approved positions in accredited programs, of which over 75 percent are currently filled. More than 1,000 individuals have graduated from ACGME-I accredited programs.
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