Charles P. Clayton
The Accreditation Council for Graduate Medical Education (ACGME) posted two new frequently asked questions (FAQs) concerning “extreme emergent situations (e.g., epidemics)” to its website Monday, September 21, 2009. In the posting, ACGME states, “Decisions regarding a resident’s involvement in local extreme emergent situations must take into account…his/her multiple roles as a student, a physician, and an institutional employee.”
In articulating these policies, ACGME defined extreme emergent situations as “a local event (such as a hospital-declared disaster for an epidemic) that affects resident education or the work environment but does not rise to the level of an ACGME-declared disaster.”
In response to the first question, “What principles should a Sponsoring Institution apply when considering residents for clinical duties during a local extreme emergent situation,” ACGME reminds institutions that the institutional accreditation requirements mandate an institutional disaster plan. With respect to principles, ACGME notes that “Residents are, first and foremost, physicians, whether they are acting under normal circumstances or in extreme situations.” In addition, the FAQ states, “Residents are students. Residents should not be first-line responders without appropriate supervision given the clinical situation at hand and their level of training and competence.”
The response to the second question outlines the process for notifying ACGME about emergent situations. In essence, first contact with ACGME should take place through the designated institutional official (DIO); the DIO should contact the executive director of the ACGME Institutional Review Committee to notify the council if an emergent situation causes “serious, extended disruption to resident assignments, educational infrastructure or clinical operations.” After institutional notification has been acknowledged, individual residency program directors may contact the executive directors of the respective residency review committees to discuss specialty-specific concerns.