Nicole V. Baptista
The Accreditation Council for Graduate Medical Education (ACGME) posted the revised program requirements for internal medicine residency programs Tuesday, September 30, 2008. The revised program requirements are scheduled to take effect July 1, 2009.
Most notably, ACGME revised the continuity clinic requirement to read, "Each resident’s longitudinal continuity experience must include a minimum of 130 distinct half-day outpatient sessions, extending at least over a 30-month period, devoted to longitudinal care of the residents’ panel of patients." The revised program requirements also reduce the ratio of residents or other learners to faculty preceptors in continuity clinic from 5:1 to 4:1.
The caps on the number of patients for which interns and residents can be responsible have decreased in the revised program requirements. On inpatient rotations, a first-year resident "must not be responsible for the ongoing care of more than 10 patients." When a resident is supervising one first-year resident, "the supervising resident must not be responsible for the ongoing care of more than 14 patients." A resident supervising more than one first-year resident must not be responsible for more than 20 patients. These numbers have decreased from 12, 16, and 24, respectively.
The sponsoring institution requirements include several new mandates surrounding fostering a culture of quality improvement and patient safety. The requirements mandate sponsoring institutions "provide residents with access to training using simulation" and access to an electronic health record (EHR). According to the revised requirements, if a program does not have an existing EHR, “institutions must demonstrate institutional commitment to its development and progress towards its implementation.”
Contrary to earlier considerations, ACGME did not change the program requirements to prohibit the required time residents spend in the emergency department to count toward the overall requirement for ambulatory training. Instead, the requirements state, "Emergency medicine may count for no more than two weeks toward the required 1/3 ambulatory time."
During the 2008 Association of Program Directors in Internal Medicine Fall Meeting, which will be held in conjunction with Academic Internal Medicine Week 2008, Residency Review Committee for Internal Medicine Chair Rosemarie L. Fisher, MD, and other members of the committee and staff will be present to discuss the revised program requirements.