The “alphabet soup” of oversight organizations in family medicine residency education can be overwhelming for program leadership new to their role. Given the recent growth in the number of family medicine residency programs, and that program leadership turnover is high (one study found that family medicine residency program directors stay in their role for a median of 4.5 years),1 the learning curve can be steep for figuring out who you are accountable to on behalf of your learners, and for what. In this article, we will clarify the roles of 2 of the principal organizations family medicine program directors are accountable to: The American Board of Family Medicine (ABFM) and the Accreditation Council for Graduate Medical Education (ACGME). ABFM and ACGME work closely to ensure that resident physicians are well-prepared to become independent practitioners of family medicine upon the completion of their training.
ABFM
ABFM is one of the 24 boards that make up the American Board of Medical Specialties. “ABFM’s mission is to improve the health of the public through certification… training standards… research… leadership development… collaboration.”1 Training standards prepare resident physicians for the Family Medicine Certification process and include completion of knowledge self-assessment exercises and performance improvement activities in addition to completion of an accredited residency training program. Accredited training programs include 3-year American Osteopathic Association (AOA)-Accredited Family Medicine Residency Training Programs, or an AOA program that has received ACGME accreditation or preaccreditation, or an ACGME-accredited program. Successful passage of a Board Certification Exam, which is typically completed toward the end of the PGY-3 year or after completion of training, is also a requirement for Board Certification.
Program directors and leadership must ensure that the following requirements are met in order for a trainee to be eligible for Board Certification:
Completion of full 36 calendar months of residency training, which includes 12 months in each of the PGY-1, PGY-2 and PGY-3 year, with the last 2 years of training having been completed at the same residency program
Each year of residency must include a minimum of 40 weeks of continuity clinic experience (exceptions allowed if program has received a waiver of this requirement)
Residents must complete a minimum of 1,650 in-person patient encounters in the continuity practice site
At the completion of residency training, program director must verify that the graduate has met all requirements and is ready for autonomous practice
The new ABFM Family Leave Policy states that a resident can take up to 12 weeks away from the program within a given academic year without requiring an extension of training, with up to 8 weeks attributable to family leave, and up to 4 weeks for other leave as allowed by the program, as long as the resident has at least 40 weeks of formal training in the year in which they take family leave. A resident may take up to a maximum of 20 weeks of leave over the 3 years of residency without requiring an extension of training. This maximum allowable time away from training includes vacation time and other institutional allowances. If more than 20 weeks leave were taken over the 3 years of residency, an extension of the resident’s training will be necessary to cover the duration of time that the individual was away from the program in excess of 20 weeks.
ACGME
ACGME “accredits Sponsoring Institutions and residency and fellowship programs, confers recognition on additional program formats or components, and dedicates resources to initiatives addressing areas of import in graduate medical education.” In addition to the common program requirements that apply to all residency programs accredited by ACGME, the ACGME Review Committee for Family Medicine (ACGME FM-RC) proposes specialty-specific requirements that must be met in order to maintain accreditation as a residency program.
The ACGME Family Medicine accreditation requirements are reviewed and updated annually, and include expectations regarding sponsoring institutions, participating clinical practice sites, resources that should be available to residents, faculty expectations, program leadership and faculty qualifications and responsibilities, clinical curriculum content guidelines, feedback and evaluation of residents, faculty, and the program, the assignment of a Clinical Competency Committee, physician well-being, and work hours, to name a few.
Rotation requirements: some clinical domains have requirements in minimum number of patient encounters and/or minimum number of hours or weeks spent on a service
Learning activities: scholarly activity, quality improvement in addition to didactics
Milestones: competency-based summative evaluation tool completed twice a year for each resident to demonstrate progression “by residents/fellows from the beginning of their education through graduation to the unsupervised practice of their specialties.” They neither represent the entirety of the dimensions of the 6 domains of physician competency, nor are they designed to be relevant in any other context, including program accreditation or final determination of a resident’s graduation from residency.
Annual faculty and resident surveys: online surveys distributed to all residents and faculty that are used to obtain feedback on the residency program and guide future program improvement efforts as part of the annual program evaluation. The required completion rate for both the resident/fellow and faculty survey is 70%. Programs failing to meet this threshold will not receive reports. When programs meet the required completion rate, and there are 4 or more people scheduled to participate in a survey, aggregated and anonymized survey data reports will be available. Programs that do not reach the 70% response threshold flag as noncompliant and are highlighted as such for the review committees, which may take further action.
Annual program evaluation (APE): mandatory report to ACGME that provides a “snapshot” of the residency program, including summary of each resident, report on scholarly activity completed by residents and core faculty, and program improvement plan to address areas of growth identified in the annual faculty and resident surveys. This information is submitted to ACGME via the accreditation data system.
Accreditation data system (ADS or WebADS): data collection system to collect, organize, and maintain information for accreditation and recognition purposes. Information about program, residents, graduates, faculty, and curriculum is updated annually in ADS as part of the annual program evaluation
Self-study: “an objective, comprehensive evaluation of the residency or fellowship program” that uses the results of sequential annual program evaluation results to assess efforts to improve the program over time
Site visits, either in person or virtual, are conducted by the ACGME as part of the accreditation process to assess compliance with institutional and program requirements. Site visits typically include interviews with program leadership and residents.
Meeting the objectives of the ABFM and ACGME is but one aspect of program directors’ and assistant/associate program directors’ job duties. Table 1 provides an overview of the 2 organizations. The variety of family medicine program types, settings, and structures make it difficult for 1 resource to meet the needs of all program directors when questions arise. It is vital to have a community of peers to whom one can pose questions, receive feedback, and ask questions in the ever-changing world of graduate medical education. One such resource is the Association of Family Medicine Residency Directors (AFMRD), which provides a number of resources to program leadership, such as the PD Toolbox and Resource Library, in addition to an active, collaborative online community where members can pose questions and benefit from the expertise of fellow program directors across the country. Directors of osteopathic education may use the American Osteopathic Board of Family Physicians website as a resource for designated osteopathic residents desiring AOA board certification in Family Medicine.
Overview of ABFM and ACGME
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