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ACCREDITATION COUNCIL FOR GRADUATE MEDICAL

EDUCATION

GLOSSARY

TERMS

March 19, 2009

ACGME GLOSSARY

OF TERMS

Academic

Appointment: An

appointment to a faculty

category (e.g.

professor, Associate

Professor, Adjunct

Clinical

Instructor,

etc)

degree-granting

(e g

BS BA

MA MD DO

PhD, etc

)

school,

college, or university

Accreditation: A

voluntary process of

evaluation

and

review based on published,

standards

and

following

prescribed

process, performed by

non-governmental

agency of peers.

Applicant:

An M.D. or D.C. invited

interview

with

GME program.

Assessment:

An ongoing process

gathering

and

interpreting

information

about a

learner’s

knowledge, skills, and/or

behavior.

At-Home

Call (see also Pager

Call): A

call taken from outside

the assigned site.

Categorical

Resident (also see

“Graduate

Year 1”): A resident

who enters

program

with the

objective of completing

the entire

program.

Certification:

A process

provide

assurance to the

public that a certified

medical

specialist

has successfully

completed an

approved educational

program and

an evaluation,

including an

examination process

designed to assess

the knowledge,

experience and

skills requisite

to the

provision

of high quality care

in a particular

specialty.

Chief

Resident: Typically,

position in the

final

year

the residency (e.g., surgery)

or in

the

year after the residency

is completed (e.g.,

internal medicine

and

pediatrics).

Citation: A

finding of

Review Committee

that a

program or an institution

is failing to

comply

substantially

with a particular

accreditation standard

or ACGME

policy

procedure.

Clinical

Supervision: A

required faculty

activity involving the

oversight and direction

patient

care

activities

that are

provided

residents/fellows.

Combined Specialty

Programs:

Programs recognized

by two or more

separate specialty

boards to

provide

GME

particular

combined

specialty. Each

combined specialty

program is

made up of two or three

programs,

accredited

separately

by the ACGME

at the same institution.

Common Program

Requirements: The

set of ACGME

requirements that

apply

all

specialties and

subspecialties.

Competencies:

Specific

knowledge, skills,

behaviors and attitudes

and

the appropriate

educational experiences

required of

residents to complete

GME programs.

Complement:

The maximum number

residents

or fellows approved

by a Residency

Review

Committee

per year and/or per

program based

upon availability

adequate

resources.

Compliance:

program’s

institution’s

adherence

to a

set

of prescribed requirements.

Confidential:

Information intended

to be

disclosed

only to an authorized

person; that

evaluation

is deemed

confidential

does

not imply that

the source of the evaluation

anonymous.

Consortium:

An association of two or more organizations, hospitals, or institutions that have

come together

pursue

common objectives (e.g., GME).

Continuous time on

duty: The

period

that a

resident

or fellow is in the hospital (or other

clinical care setting) continuously,

counting

the resident’s (or fellow’s) regular scheduled

day,

time

call,

and

the

hours a resident (or fellow) remains on duty after the end of the on-call

period to transfer the care of patients

and

for didactic activities.

Core Program:

See “Specialty Program”

Cycle Length: The

interval between a final accreditation action and the target date identified

for the next site visit.

Designated Institutional Official (DlO): The individual

in a

sponsoring institution who has

the

authority and responsibility for

all

of the ACGME-accredited

GME

programs.

Didactic: A kind of systematic instruction

means of planned learning experiences, such

conferences or

grand

rounds.

Disaster: An event or set of events causing significant alteration to the residency/fellowship

experience

one or

residency/fellowship programs. Hurricane

Katrina

is an example

of a

disaster.

Duty-Hours:

All

clinical

and academic activities related to the residency/fellowship

program,

i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the

provision for transfer of patient care, time spent in-house during call activities, and scheduled

academic

assignments

such

conferences.

(See

Common Program Requirements)

ECFMG Number: The identification number assigned by the Educational Commission for

Foreign Medical

Graduates

(ECFMG) to each international medical

graduate physician

who

receives a

certification

from ECFMG.

Elective:

An educational experience approved for inclusion in the program curriculum and

selected by the resident in consultation with the program director.

Essential: (See

“Must”)

Faculty: Any individuals who have received a formal assignment to teach resident/fellow

physicians. At some sites appointment

the medical staff of the hospital constitutes

appointment

to the faculty.

Fellow:

physician in

program of graduate medical education accredited by the ACGME

who has

completed the requirements for eligibility for first board certification in the specialty.

The term

“subspecialty

residents” is also applied to such

physicians.

Other uses of the term

“fellow” require modifiers for precision and clarity, e.g., research fellow.

Fellowship: see “subspecialty program”

Fifth Pathway: One of several ways that

individuals who obtain their undergraduate medical

education

abroad can enter GME in the United States. The fifth pathway is a

period of

supervised clinical training for students who

obtained

their premedical

education in

the

United

States, received

undergraduate medical

undergraduate

abroad, and passed Step

I of the

United

States

Medical Licensing Examination.

After

these

students successfully complete a year

of clinical training

sponsored

by an

LCME-accredited US medical school and pass USMLE Step

2, they become

eligible for

ACGME-accredited residency as an international medical

graduate.

Focused

Institutional

Site

Visit:

on-site review requested by the Institutional

Review

Committee (IRC)

and conducted

by a

senior member of the ACGME

Department of Field

Activities (DFA). The focused

institutional

site

visit concentrates on institutional oversight of

compliance with

duty

hour standards,

potential egregious violations related to resident safety

and security, or serious disruption to

the resident educational and work environment at a

sponsoring institution following a

disaster

(see

AGME Policies and Procedures, II.H.)

Formative

Evaluation:

Assessment of a resident/fellow with the primary

purpose of providing

feedback for improvement as well as to

reinforce skills and behaviors that meet established

criteria

and

standards without passing a

judgment in the form of a permanently recorded grade

or score.

Graduate Medical Education: The period

of didactic and clinical education in a medical

specialty which follows the completion

recognized undergraduate medical education and

which prepares physicians for

the independent practice of medicine in that

specialty, also

referred to as residency

education. The term “graduate medical

education’ also applies

the

period of didactic and clinical

education in

medical subspecialty which

follows the completion

of education in a

recognized medical specialty

and

which prepares physicians for the

independent

practice of medicine

in that subspecialty.

Graduate-Year Level: Refers to a

resident’s current year of accredited GME.

This designation

may

or may not correspond to the

resident’s particular year in a program.

For example,

resident in pediatric cardiology could be

in the first program year of the pediatric

cardiology

program

but in his/her

fourth graduate year of

GME (including the

prior years of pediatrics.)

Also referred to as ‘post

graduate year’ or ‘PGY”.

In-House Call: Duty

hours beyond the normal

work

day

when residents are required to be

immediately

available

the

assigned

institution.

Innovation: Experimentation

initiated

the program level which may

involve an individual

program,

group of residents (e.g.,

PGYI residents) or an individual resident (e.g.,

chief

resident).

Institutional Review: The process

undertaken by the ACGME to

determine whether

sponsoring institution offering

GME programs is in substantial

compliance with the Institutional

Requirements.

Integrated:

site may be

considered integrated when the program director a)

appoints the

members of the faculty and is

involved in the

appointment of the chief of service at the

integrated site, b)

determines all rotations and

assignments

residents, and

is responsible

for

the overall conduct of the

educational program in the

integrated site. There must be a

written

agreement between the

sponsoring institution and the integrated site stating that these

provisions are in effect. This

definition does not apply to

all specialties.

(See

specific Program

Requirements)

Intern: Historically, a designation

for individuals in the first year of GME. This term

no longer

used by the ACGME.

Internal Moonlighting: Any

hours a resident work for compensation at the sponsoring

institution

any of

the sponsor’s primary clinical sites.

Internal Review: A

self-evaluation process undertaken by sponsoring institutions ACGME

accredited programs

to judge whether each is in substantial compliance with accreditation

requirements.

International Medical

Graduate (1MG): A graduate from a medical school outside the United

States and Canada (and not accredited

by the

Liaison Committee

Medical

Education).

IMGs

may be citizens of the United

States who chose to be educated elsewhere or non-citizens who

are

admitted

to the United States

by US

Immigration authorities.

In-Training Examination: Formative examinations

developed to evaluate resident/fellow

progress

in meeting

the educational objectives of a residency/fellowship program. These

examinations may

be offered by certification boards or specialty societies.

JC:

Joint Commission,

formally known as the Joint Commission on Accreditation of Healthcare

Organizations

or JCAHO, which evaluates

and

accredits health care organizations

in the United

States.

LCME: Liaison Committee

on Medical

Education,

which accredits programs of medical

education leading

the

M.D. in the United States and in collaboration with the Committee on

Accreditation of Canadian

Medical Schools (CACMS), in Canada.

Letter

of Notification:

The official communication from a Review Committee that states the

action taken by the Review Committee.

Master Affiliation Agreement:

A written document that addresses GME responsibilities

between a sponsoring institution and

major participating site.

Medical School Affiliation: A formal relationship between a medical school and a sponsoring

institution.

Moonlighting: Patient

care

activities

external to the educational program that residents/fellows

engage in

sites used by the educational program (internal moonlighting) and other healthcare

sites.

Must: A term used to

identify

a requirement which is mandatory or done without fail. This term

indicates an

absolute requirement.

National

Resident

Matching Program (NRMP): A private, not-for-profit corporation

established in 1952 to provide a uniform date of appointment

positions in graduate medical

education in the United

States.

Five organizations

sponsor the NRMP: American Board of

Medical Specialties, American Medical Association, Association of American Medical Colleges,

American Hospital Association, and Council of Medical Specialty Societies.

New Patient:

Any

patient for whom the resident/fellow has not previously provided care. An

individual Review Committee may further define new patient

(See

Program Requirements).

Night

Float: Rotation or educational

experience designed

either eliminate in-house call or to

assist other residents during the night. Residents assigned to night

float are assigned on-site

duty during evening/night shifts

and

are responsible for admitting or

cross-covering patients until

morning and

do not

have daytime assignments. Rotation must

have an educational focus.

Notable

Practice: A

process

practice that a Review Committee or

other ACGME

committee

deems worthy of notice. Notable

practices are shared through the ACGME

website or

other

ACGME publications

provide programs and

institutions with additional resources for resident

education.

Notable practices

do j

create additional requirements for

programs

institutions.

One Day Off: One (1) continuous 24-hour period free from

all administrative, clinical and

educational activities.

Ownership

of Institution: Refers to

the governance, control, or type of

ownership of the

institution.

Pager

Call: A

call taken from outside the assigned site.

PDSA (Plan-Do-Study-Act):

A four

part

method

for discovering and

correcting assignable causes to improve the quality of

processes;

the

method may

applied to individual

learning, courses, programs, institutions,

and systems, in repeated cycles.

Pilot:

ACGME-approved project, which is initiated by the

Review Committee and involves

several residency/fellowship programs that

elect

participate.

Preliminary

Positions:

Designated

Positions:

Positions for residents who have

already been

accepted

into

another

specialty, but who are completing

prerequisites for that specialty (see Program

Requirements for Surgery).

Non-Designated

Positions: Positions for residents who at the time

of admission

to a

program

have not been accepted into any

specialty

(see

Program Requirements for

Surgery).

Primary Clinical Site: If the

sponsoring institution is a hospital, it is by

definition

the

principal

primary teaching

hospital for the

residency/fellowship program. If the sponsoring institution is a

medical school,

university, or consortium of

hospitals, the hospital that is used most commonly

the residency/fellowship program

is recognized as the primary

clinical

site.

Program: A

structured educational

experience in graduate medical education designed to

conform to the

Program Requirements of a

particular

specialty/subspecialty, the satisfactory

completion of which may result in

eligibility for board certification.

Program

Director: The one physician

designated with authority and accountability for the

operation

of the

residency/fellowship program.

Program Evaluation: Systematic

collection and analysis of information related to the design,

implementation, and

outcomes of a resident

education program, for the purpose of monitoring

and improving

the quality and

effectiveness

of the program.

Program Information Form

(PIF): The

PIE

is the document completed by the

program director

preparation for

a site-visit. The document is a compilation of requested information that

reflects

the

current status of the educational program. The PIE is organized in two parts: the

Common PIF,

which addresses the program’s compliance with the Common Program

Requirements,

and

the

specialty or subspecialty specific PIE, which addresses

compliance

with

the specialty or subspecialty

specific

program requirements. The Common PIE is electronically

generated through the Accreditation

Data System.

Program Letter of Agreement (PLA):

written document that addresses GME responsibilities

between an individual

accredited program and a site

other

than the sponsoring

institution

which residents receive

required

part

of their education.

Program Merger: Two or more programs that combine

create

single program. One

program may

maintain continued accreditation while accreditation is voluntarily

withdrawn

from

the other program or programs. Alternatively, both programs may be withdrawn and a

new

program may be established.

Program Year: Refers

the current year of education within a specific program; this

designation may or may not correspond

the resident’s graduate year level.

Required: Educational experiences within a residency/fellowship program designated

for

completion by all residents/fellows.

Resident: A physician in an accredited graduate medical education specialty program.

Residency: A program accredited

provide a structured educational experience designed to

conform to the Program Requirements of a particular specialty.

Rotation: An educational

experience

of planned activities in selected settings, over

specific

time

period, developed to meet goals and objectives of the program.

Scholarly Activity: An opportunity for

residents/fellows

and faculty to

participate in research,

well as organized clinical discussions, rounds, journal clubs, and conferences.

In addition,

some

members of the

faculty should

also demonstrate scholarship through one or more of the

following:

peer-reviewed

funding;

publication of

original research or review articles in peer-

reviewed journals or chapters in textbooks; publication or presentation of case reports or clinical

series

at local, regional, or national professional and scientific society meetings; or participation

national committees or educational

organizations.

(See

Common Program Requirements)

Shall:

(See

must)

Short call: Responsibility for admitting patients to the teaching service during the early part of

the

day. Residents begin call in the

morning,

admit

patients until

some

designated time in the

afternoon

or late morning and

do not

stay in the hospital over night.

Should: A term used to designate requirements so important that their absence must be

justified.

A program or institution

may be cited

for failing

comply with

requirement that

includes

the

term

‘should’.

Site:

An organization

providing educational

experiences

or educational

assignments/rotations

for residents/fellows.

Major

Participating Site:

Review Committee-approved

site to which all

residents

least one program

rotate for a required

educational

experience, and

for which

master

affiliation

agreement must be in

place. To be

designated as a

major participating

site in a

two-year

program,

all residents must spend

least four

months

in a

single required rotation

or a

combination

of required

rotations across both

years

of the

program. In programs

three

years or longer,

all residents must

spend at least six

months in a

single required

rotation or a

combination of required

rotations

across all

years

the

program. The

term

“major

participating site” does

not apply

to sites

providing

required rotations

in one

year

programs. (see

“Master Affiliation

Agreement”)

Participating

Site:

An organization

providing educational

experiences

or educational

assignments/rotations

for

residents/fellows.

Examples of sites

include: a university,

medical school, a

teaching hospital

which

includes

its ambulatory

clinics and related

facilities,

private medical practice

or group

practice,

nursing

home, a

school

public

health,

a health

department,

a federally

qualified health

center, a

public

health agency, an

organized health

care delivery

system, a

health

maintenance

organization (HMO),

a medical

examiners office, a

consortium or an

educational

foundation.

Specialty

Program: A

structured educational

experience

in a field of

medical practice following

completion of medical

school and,

in some cases,

prerequisite

basic clinical education

designed

to conform to

the

Program

Requirements

particular

specialty; also known

as ‘core’

programs.

Sponsoring Institution:

The

organization (or

entity) that assumes

the

ultimate

financial and

academic responsibility

for

a program

GME. The

sponsoring institution

has the primary

purpose of

providing

educational

programs and/or

health

care

services

(e.g., a university,

medical

school,

a hospital, a

school of public

health,

health

department, a

public health

agency,

organized

health

care

delivery system, a

medical examiner’s

office, a

consortium, an

educational foundation).

Clarification:

When the

sponsoring institution

is a

non-rotation

site the major

associated hospital

is the

participating

rotation site.

Additionally, for multiple

ambulatory

medical

sites

under

separate

ownership

from

the

sponsoring

institution one central

or corporate

site (and

address)

must

represent the

satellite clinics

(that

are located

within 10 miles

of the main site).

Subspecialty

Program:

structured

educational

experience following

completion

prerequisite

specialty

program

in GME

designed to

conform

the Program

Requirements

particular

subspecialty.

Dependent

Subspecialty

Program: A

program that is required

function

in conjunction

with an accredited

specialty/core

program,

usually

reviewed conjointly with

the

specialty

program, usually