RESIDENCY EDUCATION—COMPETENCY AND INNOVATION

The authors are to be commended for their push for more flexibility from the ACGME with regards to innovation and experimentation. Although I speak for myself and not for the FM-RC in my role as a current member I can assure you that I share the sentiments expressed in your editorial and hope to see more proposals for innovation in residency education from accredited programs.

Contrary to the authors assertion that "... innovation can only be implemented if all existing requirements are met", I feel duty bound to point out that the ACGME has a mechanism in place to waive requirements, with instructions listed on the ACGME FM-RC website (http://www.acgme.org/acWebsite/navpages/nav_program_experimentation. asp) and elsewhere (page 103 of the ACGME policies and procedures http://www.acgme.org/acWebsite/about/ab_ACGMEPoliciesProcedures.pdf)

This mechanism allows exactly what the authors call for; namely a waiver of common, program or institutional requirements in the implementation of experimental educational settings. Among other things it requires a clear rationale for the variation or exception to requirements, along with a monitoring process that informs the outcome of the experiment.

In addition, programs may choose to innovate without requesting a waiver of requirements if they are willing to take a few citations but remain in substantial compliance with the minimum requirements. Indeed, many residencies without experimental programs maintain their accreditation despite persistent, if minor, deficiencies that accrue from design rather than default.

Competing interests:   None declared