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Residency Requirements Concerning Grievances and Educational Experiences
Douglas Beall, MD
JAMA. 1999;282:496.
The last 4 Resident Physician Forum columns have explained many of the requirements set by the Accreditation Council for Graduate Medical Education (ACGME) for all institutions that train resident physicians. The remaining requirements are presented below. Next week's column will explain the procedures that a resident must follow when filing a complaint with the ACGME against a program.
Resident Grievances
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The institution must ensure an educational environment in which residents may raise and resolve issues without fear of intimidation or retaliation. To achieve this, the institution must:
- Provide an organizational system through which residents can communicate and exchange information with the institution regarding the working environment and education. This system could be a house staff organization, an ombudsperson, or another forum. Residents must be able to raise concerns in a confidential and protected manner.
- Establish and implement fair institutional policies and procedures regarding academic or other disciplinary actions taken against residents. For actions that could result in a resident's dismissal or could significantly threaten a resident's intended career development, the institution must establish and implement fair policies and procedures for the adjudication of resident grievances.
- Ensure that each residency program establishes and implements formal written criteria for resident selection, evaluation, promotion, and dismissal.
- Ensure that each program establishes an appropriate work environment and reasonable duty hours.
- Give residents the opportunity to submit confidential written evaluations of the faculty and the educational experiences to the program director or to a designated institutional official at least annually.
Educational Activities
Institutions must ensure that residents have the opportunity to:
- Develop a personal program of learning to foster continued professional growth with guidance from the teaching staff.
- Participate in safe, effective, and compassionate patient care, under supervision, commensurate with their level of advancement and responsibility.
- Participate fully in the educational and scholarly activities of their program and, as required, assume responsibility for teaching and supervising other residents and students.
- Participate, as appropriate, in institutional programs and medical staff activities and on institutional committees and councils whose actions affect residency education and/or patient care.
- Review ethical, socioeconomic, medical/legal, and cost-containment issues that affect GME and medical practice. The curriculum must also provide an appropriate introduction to communication skills and research design, statistics, and critical review of the literature necessary for acquiring skills for life-long learning.
While residents are responsible for performing their duties to their best ability, institutions are responsible for providing enough resources and support so that residents can meet those responsibilities. The ACGME's Institutional Requirements provide a list of the expected resources and support necessary for high quality residency education. By understanding these requirements, the quality of graduate medical education will be improved.
Resident Representative to ACGME,
1996-1998
Wichita Falls, Tex
Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.
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