Effect of Changes in Graduate Medical Education Funding on Emergency Medicine Residency Programs
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Abstract. Objective: To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training programs. Methods: A 34‐question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGME)‐accredited EM residency programs in the United States in the fall of 1998, requesting information concerning the impact of changes in GME funding on various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. Results: One hundred one completed surveys were returned (88% response rate). Seventy‐one (70%) of the responding EM residency programs were PGY‐I through PGY‐III, compared with 55 (61%) of the responding programs in 1996. The number of PGY‐II through PGY‐IV programs decreased from 25 (28%) of responding programs in 1996 to 17 (16%). The number of PGY‐I through PGY‐IV programs increased slightly (13 vs 10); the number of EM residency positions remained relatively stable. Fifteen programs projected an increase in their number of training positions in the next two years, while only three predicted a decrease. Of the respondents, 56 programs reported reductions in non‐EM residency positions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty‐six respondents reported a reduction in the number of non‐EM residents rotating through their EDs, and of these, 11 programs reported this had a moderate to significant effect on their ability to adequately staff the ED with resident physicians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty‐seven EM programs reported no change in faculty size due to funding issues. Sixty‐two programs reported no change in the total number of hours of faculty coverage in the ED, while 34 programs reported an increase. Three EM programs reported recommendations being made to close their residency programs in the near future. Conclusions: Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM programs structured in a PGY‐I through PGY‐III format (with a corresponding decrease in the number of PGY‐II through PGY‐IV programs); a decrease in the number of non‐EM residents rotating through the ED; restriction of resident applicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clinical hours without an increase in faculty size.Keywords:
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Becoming compliant with the Accreditation Council for Graduate Medical Education (ACGME) requirements for scholarly activity and remaining compliant over time requires time and attention to the development of an environment of inquiry, which is reflected in detailed documentation submitted in program applications and annual updates. Since the beginning of the next accreditation system, all ACGME programs have been required to submit evidence of scholarly activity of both residents and faculty on an annual basis. Since 2014, American Osteopathic Association–accredited programs have been able to apply for ACGME accreditation under the Single Graduate Medical Education Accreditation initiative. The Residency Program Director, Chair, Designated Institutional Official, Faculty, and coordinator need to work cohesively to ensure compliance with all program requirements, including scholarly activity in order for American Osteopathic Association–accredited programs to receive Initial ACGME Accreditation and for current ACGME-accredited programs to maintain accreditation. Fortunately, there are many ways to show the type of scholarly activity that is required for the training of surgeons. In this article, we will review the ACGME General Surgery Program Requirements and definitions of scholarly activity. We will also offer suggestions for how programs may show evidence of scholarly activity.
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Certification and Accreditation
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Abstract. Objective: To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training programs. Methods: A 34‐question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGME)‐accredited EM residency programs in the United States in the fall of 1998, requesting information concerning the impact of changes in GME funding on various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. Results: One hundred one completed surveys were returned (88% response rate). Seventy‐one (70%) of the responding EM residency programs were PGY‐I through PGY‐III, compared with 55 (61%) of the responding programs in 1996. The number of PGY‐II through PGY‐IV programs decreased from 25 (28%) of responding programs in 1996 to 17 (16%). The number of PGY‐I through PGY‐IV programs increased slightly (13 vs 10); the number of EM residency positions remained relatively stable. Fifteen programs projected an increase in their number of training positions in the next two years, while only three predicted a decrease. Of the respondents, 56 programs reported reductions in non‐EM residency positions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty‐six respondents reported a reduction in the number of non‐EM residents rotating through their EDs, and of these, 11 programs reported this had a moderate to significant effect on their ability to adequately staff the ED with resident physicians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty‐seven EM programs reported no change in faculty size due to funding issues. Sixty‐two programs reported no change in the total number of hours of faculty coverage in the ED, while 34 programs reported an increase. Three EM programs reported recommendations being made to close their residency programs in the near future. Conclusions: Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM programs structured in a PGY‐I through PGY‐III format (with a corresponding decrease in the number of PGY‐II through PGY‐IV programs); a decrease in the number of non‐EM residents rotating through the ED; restriction of resident applicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clinical hours without an increase in faculty size.
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The development and evaluation of graduate medical education in the United States from the late 19th century to the present are founded on the structure, role, and function of the accrediting bodies (the Accreditation Council for Graduate Medical Education and the Residency Review Committees). The general and specific requirements for accreditation of orthopedic programs, the processes for accreditation of existing and new residency programs, and the current status of fellowship accreditation are continuously under evaluation.
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Beginning in 2020, all residency programs will be accredited by the Accreditation Council for Graduate Medical Education (ACGME). Programs accredited by the American Osteopathic Association (AOA) that do not achieve ACGME pre-accreditation status by 2020 will be forced to close, resulting in loss of graduate medical education slots and affecting the physician workforce locally and nationally. Current ACGME programs are in a position to help consult, support, and learn from local AOA-only programs as they work toward meeting ACGME accreditation requirements, but to date there have been only limited collaborations. A regional network of ACGME- and dually accredited family medicine residency programs ("the Network") and family medicine programs solely accredited by the AOA recognized the imperative to support the AOA-only programs with their accreditation transitions to preserve their primary care residency positions. This article describes the inputs, activities, outputs, and outcomes of these collaborative efforts to establish communications and strategies using a logic model program "road map" format. Initial efforts included a collaborative conference and ongoing consultations and workshops. This model can be replicated for program collaborations in other locations.
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The American Academy of Family Physicians (AAFP) and the Accreditation Council for Graduate Medical Education’s (ACGME) program requirements for residency education in family practice acknowledge the importance of research and other scholarly activity in residency training.[1][1] Included in the
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Preparing family medicine physicians to meet the needs of their patients is a fundamental goal of residency training. These needs shift, and so training must also adapt. The revised Accreditation Council for Graduate Medical Education (ACGME) requirements for GME in family medicine call on residency
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