THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME)
The Accreditation Council for Graduate Medical Education (ACGME) is a private professional organization with the responsibility for ensuring the quality of 8,400 accredited residency education programs in 121 specialty and subspecialty areas of medicine.  Collectively, the programs are responsible for the education of more than 105,000 residents.  This number of accredited programs and residents makes the ACGME one of the largest private accrediting agencies in the country, if not the world. 

The ACGME relies on a system of specialty experts to articulate the accreditation decisions governing the accredited programs.  There are 27 committees known as Review Committees (RCs) that carry out the function of reviewing and deciding the status of the accredited programs.  There is a Residency Review Committee for each of the major specialty areas with responsibility to accredit programs in the general specialty and related subspecialties, and one for Transitional Year programs.  Members of these Committees are physicians trained in the particular discipline.  Often, they are medical educators who have gained a reputation for expertise in residency education in their particular medical specialties.  Joining a Review Committee is considered a prestigious appointment and offers an individual the opportunity to make a meaningful contribution to medical education.  Compliance with the ACGME’s requirements for institutions that sponsor accredited residency education programs is assessed periodically by the Institutional Review Committee (IRC).  

The ACGME and Residency and Institutional Review Committees are committed fully to the task of improving the quality of resident education in the United States.

THE ACCREDITATION SITE VISIT
The ACGME reviews approximately 2,000 programs a year.  On average all residency education programs in the nation are site visited about every 3.5 years.  The period between site visits ranges from one to five years, with a longer time generally indicating greater confidence about the program’s ability to provide high-quality education.  In order to accomplish this task, the ACGME and its RCs are supported by a staff of 135 individuals who carry out various staff functions.  Approximately half of these serve the RCs directly, and 35 individuals are responsible for carrying out site visit activities, including the ACGME field representatives.  The remaining ACGME staff carries out various administrative, research and support functions.

The periodic review of programs begins with an on-site inspection.  This activity is administered by the Department of Field Activities.  Two types of visits are arranged: "Specialist Site Visits" and "Field Staff Visits." In the case of Specialist Site Visits, the ACGME enlists the services of voluntary specialists in the various disciplines, and approximately 60 site visits annually are conducted by specialist site visitors.  In contrast, each field representative is expected to be knowledgeable of the Program Requirements of the more than 120 medical specialty and subspecialty areas. 

THE ROLE OF THE ACGME SITE VISITOR
In the ACGME’s approach to accreditation, the site visitor is not the decision-maker regarding the quality of the educational program but is expected to be a fact-finder who verifies and clarifies the information provided by the program in the program information form (PIF), a comprehensive self-study document the program completes prior to the visit.  This PIF and the site visitor’s report form the basis of the RC’s review and accreditation decision.  The site visitor thus serves as "the eyes and ears of the RC."  Prior to the site visit, the site visitor (field representative or SSV) is expected to have reviewed both the "Institutional and Program Requirements" governing accredited residencies as well as the program information form the individual program has prepared.  He or she conducts a series of interviews with program directors, faculty members, administrators, residents and other key personnel in order to verify that the self-study document is an accurate and complete reflection of the educational experience offered by the program to the residents being trained. 

Following the site visit, the field representative composes an objective report of the information that he/she collected during the interviews. This document is factual and non-judgmental and also addresses omissions or discrepancies between the self-study document and the information collected during the site visit by the program director, faculty or residents.  Site visitors are prohibited from making recommendations and from interjecting personal opinion into the report.  The report is intended as an objective presentation of the information gathered during the visit, without a direct or indirect effort to sway the Residency Review Committee for or against the program.

THE DEPARTMENT OF FIELD ACTIVITIES
The majority of accreditation site visits are carried out by the members of the ACGME field staff.  In 2007, the field staff of the ACGME consists of 19 full-time equivalent representatives, comprising 31 individuals. A full-time field representative is expected to carry out approximately 125 site visits per year.  The individuals serving as field representatives include physicians and other individuals with a doctoral degree. The medical specialties represented by the group of physicians include internal medicine, neurology, obstetrics and gynecology, ophthalmology, orthopaedic surgery, pediatrics, plastic surgery, preventive medicine, psychiatry and surgery.  Among the PhD members of the staff the disciplines of education, sociology, health education and public health are represented.  A significant number of field representative have been with the ACGME for 10 or more years. 
           
The director of the Department of Field Activities has responsibility for all aspects of the ACGME’s site visit process, including recruiting, training, supervision and professional development of the field representatives, as well as organizing their schedules.  Continuing professional development is achieved through a variety of means, including two week-long annual professional development workshop in which all members of the field staff participate, regular communication regarding developments in the areas of educational standards, periodic attendance as observers at Review Committee meetings, attendance at other medical education meetings, and dialogue between the field representatives and other components of the ACGME’s accreditation body.

The members of the ACGME field staff carry a heavy travel schedule to carry out their site visit assignments.  In a typical week a field representative conducts site visits of three programs.  Ordinarily he or she travels on Monday and conducts site visits on Tuesday, Wednesday and Thursday. Friday constitutes an in office day for the field representative to return completed reports and conduct other administrative activities related to their work. Schedules are developed for the field representatives four to six months in advance.  Because of the time needed by the hospitals for the preparation of the program information form, the date of the site visit and the identity of the site visitor are normally communicated to the residency program approximately 110 to 120 days before the visit. 

The role of the ACGME field representative in the accreditation process conducting an on-site survey that verifies and clarifies the information in the program’s self study and supporting documents, in accordance with the ACGME’s policies and procedures for site visits.  The members of the field staff play a crucial role in the accreditation enterprise and take satisfaction in helping the RCs formulate fair and accurate judgments about the educational quality of the programs and institutions accredited by the ACGME.

Revised: 10/17/2008