As ACGME-I expands its services to new regions, new members representing new perspectives will join the Review Committees-International. Our accreditation process is, to the best of our knowledge, the only one of its kind, in which a truly international adjudicating body of peers evaluates and speaks on behalf of those served, with a deliberate global perspective. High standards and flexibility respectful of the diversity of cultures and norms will remain our driving commitment to quality education.
The medical profession historically has had the extraordinary privilege of defining what physicians need to know in order to care for patients. In turn, the doctor-patient relationship is built upon trust. In simpler times, a mentor-apprentice relationship transferred the best way to care for patients. With increasing complexity, a different system evolved to ensure that a more comprehensive educational relationship existed.
With accreditation, a system of education has met this need. Requirements address what an institution must provide, identify the fields of faculty expertise that are necessary, define how feedback can best address gaps of knowledge and care, and specify what experience is necessary before a person may practice independently. More simply put: what is a resident or fellow supposed to learn, and how can society trust that such education will produce quality physicians?
It is from this background that ACGME-I accreditation has designated this important role to its Review Committees-International. These are the people responsible for carrying out one of Hippocrates’ most important directives: to accept the responsibility of training tomorrow’s physicians to care for patients properly. The essential elements for delivering this wisdom include the following:
- Individuals must themselves be seasoned, respected physicians who care deeply for patients Members of the Review Committees-International are selected based on their experience in teaching, their commitment to professional behavior, and their “content expertise,” so that all appropriate and necessary areas are addressed. They are themselves exemplary physicians.
- Individuals must be representative of the society they serve. The Review Committees-International include members from virtually all regions served by ACGME International, offering perspectives that center on our informal motto, “Keep standards high, while allowing flexibility.” “Content experts” from the US are included to supplement domains of knowledge and to provide experience in the accreditation process.
- Individuals are volunteers, focused solely on the task at hand. As a volunteer, each Review Committee member attends two meetings lasting two to three days each. These meetings culminate much activity between meetings, including review of individual program or institutional applications, review of requirements on a periodic basis, and participation at national and international meetings as educators. Terms are finite, so that new perspectives may be heard.
- Individuals do not judge their own programs or those in competition with their own. The avoidance of conflict of interest is key in ensuring the validity of accreditation decisions. It further protects Review Committee members from being perceived by others as directing biases toward them.
- The “wisdom of the group” is key to the accreditation model for ACGME-I. When a program applies, two separate Review Committee members review all incoming data. This is truly a time-consuming labor of love. Each member independently makes a preliminary decision. A discussion of the entire Review Committee follows these presentations, and consensus is reached after careful deliberation.
This article was contributed by Dr. Susan Day, Senior Vice President, Medical Affairs for ACGME International