Glossary of Terms

Academic Appointment: An appointment to a faculty category (e.g., professor, associate professor, adjunct clinical instructor, etc.) of a 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 requirements and following a prescribed process, performed by a non-governmental agency of peers.

Accreditation status: The official decision made by a Review Committee based on its review and assessment of a Sponsoring Institution’s or program’s compliance with the applicable requirements.

Accreditation Data System (ADS): The ADS is an online service of the ACGME-I that allows authorized program directors of accredited graduate medical education programs to input limited amounts of program information data to servers maintained by the ACGME-I or on its behalf.

Accreditation Preparedness Assessment (APA) Visit: The purpose of the APA visit is to evaluate the sponsoring institution(s)', and residency/ fellowship programs’ readiness for ACGME-I accreditation. The visit includes meetings with institution senior leadership; and with the leadership of graduate medical education endeavors, such as the individual providing institutional oversight, residency/fellowship program directors, and residents/fellows, as well as a guided tour of the facilities used in the education of residents/fellows. For a single sponsor institution, the meetings and tour usually occur over two days. The two-member assessment team includes an accreditation specialist and a member of the ACGME-I senior leadership. After the visit, the team will prepare a report to the sponsoring institution or Ministry’s leadership that describes the proposed steps and costs to receive ACGME-I accreditation for the institution(s) and residency/fellowship programs. The sponsoring institution or Ministry bears the direct cost of the APA visit, specifically, air transport (business class) and hotel arrangements for the two-member assessment team.

Advanced 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 Advanced Specialty Program Requirements of a particular specialty; also known as a ‘core’ program.

Advanced Specialty Program Requirements: International Advanced Specialty Program Requirements specify what programs must implement in terms of the educational infrastructure, and what they must demonstrate regarding the specialty-specific curriculum, resources, and experiences that are essential in the discipline. Competency-based educational outcomes in the ACGME-I six domains of clinical competency are included in the International Advanced Specialty Program Requirements.

Adverse action: The Review Committee International ‘s decision to confer an adverse accreditation status on a Sponsoring Institution or program (i.e., Accreditation Withheld, Probationary Accreditation, Withdrawal of Accreditation, , and non-voluntary Reduction in Resident Complement).

Adverse event: An injury that was caused by medical management (rather than the underlying disease), and that prolonged hospitalization, produced a disability at the time of discharge, or both.

Applicant: A physician invited to interview for a position in a graduate medical education (GME) program.

Application: The Initial or Continued Accreditation Application document is a compilation of requested information that reflects the current status of the educational program. Information is (1) entered into the ADS, addressing the program’s compliance with the International Foundational Program Requirements, and (2) provided via the Advanced Specialty or Subspecialty application, a Word document which addresses compliance with the Advanced Specialty or Subspecialty Program Requirements and is uploaded as an attachment in ADS.

Assessment: An ongoing process of gathering and interpreting information about a learner’s knowledge, skills, and/or behavior.

At-home Call (Pager Call): A call taken from outside the assigned site. Time in the hospital, exclusive of travel time, counts against the 80-hour-per-week limit, but does not restart the clock for time off between scheduled in-house duty periods. At-home call may not be scheduled on a resident's/fellow's one free day per week (averaged over four weeks).

Categorical Resident: A resident who enters a program and has the objective of completing the entire program.

Certification: A process to 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/subspecialty.

Chief Resident: Typically a position in the final year of residency (e.g., for surgery programs) or in the year after the residency is completed (e.g., for internal medicine or pediatrics programs).

Citation: A finding of a Review Committee that a program or an institution is failing to comply substantially with a particular accreditation standard or ACGME-I policy or procedure.

Clarifying Information: A Review Committee may request clarifying information that specifies information to be provided, including a due date for the clarifying information.

Clinical: Refers to the practice of medicine in which physicians assess patients (in person or virtually) or populations in order to diagnose, treat, and prevent disease using their expert judgment. It also refers to physicians who contribute to the care of patients by providing clinical decision support and information systems, laboratory, imaging, or related studies.

Clinical Competency Committee (CCC): A required body comprising three or more members of the active teaching faculty that is advisory to the program director and reviews the progress of all residents/fellows in a program.

Clinical Responsibility/Workload Limits: Reasonable maximum levels of assigned work for residents/fellows consistent with ensuring both patient safety and a quality educational experience. Such workloads, and their levels of intensity, are specialty-specific and must be thoroughly examined by an ACGME-I Review Committee before inclusion as program requirements.

Clinical Supervision: A required faculty activity involving the oversight and direction of patient care activities provided by residents/fellows.

Competencies: Specific knowledge, skills, behaviors, and attitudes and the appropriate educational experiences required of residents/fellows to complete GME programs.

Competencies: Specific knowledge, skills, behaviors, and attitudes and the appropriate educational experiences required of residents/fellows to complete GME programs. The six domains of ACGME-I competencies are Professionalism; Patient Care and Procedural skills; Medical Knowledge; Practice-based Learning and Improvement; Interpersonal and Communication Skills; and, Systems-based Practice.

Complaint: An allegation that a Sponsoring Institution or program is non-compliant with accreditation requirements

Complement: The maximum number of residents/fellows approved by the ACGME-I per program based upon availability of resources.

Compliance: A program’s or institution’s adherence to a set of prescribed requirements.

Conditional Independence: Graded, progressive responsibility for patient care with defined oversight.

Confidential Information: Information intended to be disclosed only to an authorized person; that an evaluation is deemed confidential does not imply that the source of the evaluation is anonymous.

Continued Accreditation: An accreditation status that is conferred when a Review Committee determines that a Sponsoring Institution or a program demonstrates substantial compliance with requirements.

Continuity Clinic: Setting for longitudinal experience in which residents/fellows develop a continuous, long-term therapeutic relationship with a panel of patients.

Continuous time on duty: The period that a resident/fellow is in the hospital (or other clinical care setting) continuously, counting his or her regular scheduled day and time on call, and the hours he or she remains on duty after the end of the on-call period to transfer the care of patients and for didactic activities.

Core Faculty: All physician faculty members who have a significant role in the education of residents/fellows and who have documented qualifications to instruct and supervise. Core faculty members devote at least 15 hours per week to resident, or 10 hours per week to fellow, education and administration. All core faculty members should evaluate the competency domains, work closely with and support the program director, assist in developing and implementing evaluation systems, and teach and advise residents/fellows.

Core Program: See Advanced Specialty Program.

Core Specialty: A field of medical practice that focuses on a specific set of patient care skills and a defined knowledge base. Education in a core specialty requires completion of a core residency program.

Cycle Length: The interval between an accreditation action and the target date identified for the next site visit.

Dependent Subspecialty Program: A program that is required to function in conjunction with an ACGME-I-accredited core or subspecialty program, usually reviewed conjointly with the core or subspecialty program, usually sponsored by the same sponsoring institution, and geographically proximate to the core residency program. The Continued Accreditation of this subspecialty program is dependent on the core or subspecialty program with which it is affiliated maintaining its accreditation.

Designated Institutional Official (DIO): The individual in a sponsoring institution who has the authority over and responsibility for all ACGME-I-accredited GME programs.

Didactic: A planned, systematic, instructed learning experience, such as a conference, journal club, or grand rounds.

Disaster: An event or set of events causing significant alteration to the residency/fellowship experience at one or more residency/fellowship programs.

Duty Hours: All clinical and academic activities related to the program, including patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. (See International Foundational Program Requirements).

Dreyfus Model: A developmental construct of skill acquisition using five stages, from novice to expert, with each step building on the previous. A novice is rule-based but context-free; an advanced beginner takes into account situational aspects; someone who is competent is able to devise a plan and decide what is important; someone who is proficient uses intuitive behavior in place of reasoned process; and an expert routinely makes subtle discriminations and immediate intuitive responses.

Elective: An educational experience approved for inclusion in the program curriculum and selected by a resident in consultation with his or her program director.

Essential: See Must.

Extraordinary Circumstances: Circumstances that significantly alter the ability of a sponsoring institution and its programs to support resident/fellow education. If the CEO of the ACGME-I, in consultation with the Chair of the ACGME Finance Committee, determines that a Sponsoring Institution’s ability to support resident/fellow education has been significantly altered, he or she shall invoke the ACGME-I Extraordinary Circumstances policy. (See ACGME-I Policy and Procedure Manual, subject: 18.00).

Extreme Emergent Situation: A local event (such as a hospital-declared disaster for an epidemic) that affects resident/fellow education or the work environment but does not rise to the level necessitating invocation of the ACGME-I Extraordinary Circumstances policy.

Faculty: The collective body of physicians who have individually received a formal assignment to teach resident/fellow physicians. At some sites appointment to the medical staff of the hospital constitutes appointment to the faculty.

Fatigue management: Recognition, by either a resident/fellow or supervisor, of a level of (only of a resident/fellow) fatigue that may adversely affect patient safety and their enactment of a solution to mitigate it.

Fellow: A physician in an ACGME-I-accredited program who has completed an educational program in the core 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.

Final Evaluation: The required overall evaluation to be completed by the program director for every resident or fellow upon completion of the program. The final evaluation must include verification that the resident or fellow is ready for independent practice in the specialty or subspecialty.

Fitness for duty: Describes that an individual is mentally and physically able to effectively perform required duties and promote patient safety.

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 performance standards.

Foundational Program Requirements: The set of ACGME-I requirements that outline the educational infrastructure needed for all specialty programs. To meet International Foundational Requirements, a program must demonstrate systematic evaluation of program personnel, faculty and residents/fellows; must adhere to established resident/fellow selection processes; and must ensure the availability of appropriate resources, including the faculty ratios and minimum time for program director and core faculty members, regardless of specialty.

Graduate Medical Education (GME): The period of didactic and clinical education in a medical specialty that follows the completion of a recognized undergraduate medical education and which prepares physicians for the independent practice of medicine in that specialty area, also referred to as 'residency education.' The term ‘graduate medical education’ also applies to the period of didactic and clinical education in a 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 area (or 'fellowship education').

Graduate Year Level: Refers to a resident's/fellow's current year of accredited GME. This designation may or may not correspond to the resident’s/fellow's particular year in a program. For example, a pediatric cardiology resident could be in the first program year of the pediatric cardiology program but in his or her fifth year of GME (including the four prior years of pediatrics). Also referred to as post-graduate year (PGY).

Independent Subspecialty Program: A fellowship program that is not required to function with an ACGME-I-accredited residency program in its related specialty. These subspecialty programs are dependent on an ACGME-I-accredited Sponsoring Institution. The Sponsoring Institution can sponsor programs in only one subspecialty or in more than one subspecialty.

In-house Call: Any duty hours beyond the normal work day when residents/fellows are required to be immediately available in the assigned institution.

Initial Accreditation: A status that is conferred when a Review Committee determines that an application for a new Sponsoring Institution or program substantially complies with the requirements. Initial Accreditation is considered a developmental stage.

Institutional Agreement: See Program Letter of Agreement.

Institutional Review: The process undertaken by the ACGME-I to determine whether a sponsoring institution offering GME programs is in substantial compliance with the Institutional Requirements.

Integrated PGY-1: 12 months of basic clinical skills education that is completed prior to advanced specialty rotations. The integrated PGY-1 is an option for specialties that require a broad-based clinical year prior to advanced specialty education.

Intern: Historically, a designation for individuals in the first year of GME. This term is no longer used by the ACGME-I.

Interprofessional team: The physicians and other health care professionals, including dietitians, nurses, pharmacists, physical therapists, social workers etc. as appropriate, assigned to the delivery of care for an individual patient.

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, specialty societies, colleges, or specialty training committees.

JC-I: Joint Commission International, formally known as the Joint Commission on Accreditation of Healthcare Organizations International or JCAHO-I, which evaluates and accredits health care organizations outside of the United States.

Letter of Notification (LON): The official communication from the ACGME-I that states an action taken by a Review Committee.

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

Mock Site Visit: A structured site visit by an institution or specialty expert to provide an institution or program with an assessment of its readiness to become ACGME-I-accredited, based on submitted application materials and interviews of key persons. The site visitor’s report with recommendations is reviewed by the Review Committee International, which provides a final report to the institution or program that indicates areas of non-compliance or suggestions for improvement. The mock site visit is an educational activity that is requested by the entity seeking accreditation and does not influence the future Initial Accreditation review.

Must: A term used to identify a requirement which is mandatory or done without fail. This term indicates an absolute requirement.

New Patient: Any patient for whom a resident/fellow has not previously provided care. An ACGME-I Review Committee may further define the term “new patient.” (See Foundational and Advanced Specialty Program Requirements).

Night Float: A rotation or educational experience designed to either eliminate in-house call or to assist other residents/fellows during the night. Residents/fellows assigned to night float are assigned on-site duty during evening/night shifts, are responsible for admitting or cross-covering patients until morning, and do not have daytime assignments. Such a rotation must have an educational focus.

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: See At-Home Call. Call taken from outside the assigned site.

Patient Safety Event: An adverse event, near miss, or other event resulting from unsafe conditions in the clinical care setting.

Plan-Do-Study-Act (PDSA): A four-part method for discovering and correcting assignable causes to improve the quality of processes; the method may be applied to individual learning, courses, programs, institutions, and systems, in repeated cycles.

Participating Site: An organization providing educational experiences or educational assignments/rotations/postings for residents/fellows. Examples include: a university, a medical school, a teaching hospital which includes its ambulatory clinics and related facilities, a private medical or group practice, a nursing home, a school of public health, a health department, a federally-qualified health center, a public health agency, an organized health care delivery system, a consortium, or an educational foundation.

Preliminary positions: Positions for residents who, at the time of admission to a program, have not been accepted into any specialty. Preliminary positions are permitted only in ACGME-I-accredited programs in general surgery and internal medicine. The number of residents in preliminary positions must not exceed the total number of approved positions in the first year of the categorical or specialty program. Residents are appointed to preliminary positions for a maximum of one year.

Post graduate medical education (PGME): See Graduate Medical Education (GME)

Posting: See Rotation.

Primary Clinical Site: The principal or primary teaching hospital that is used most commonly for the residency/fellowship program.

Probationary Accreditation: A status that is conferred when a Review Committee determines that a Sponsoring Institution or program fails to demonstrate substantial compliance with the Requirements.

Program: A structured educational experience in GME designed to conform to the Foundational and Advanced Specialty Requirements of a particular specialty or subspecialty, the satisfactory completion of which may result in a physician’s eligibility for certification or credentialing to practice independently in a given specialty.

Program Coordinator: The lead administrative person who assists the program director in accreditation efforts, educational programming, and support of residents/fellows.

Program Director: The one physician designated with authority over and accountability for the operation of a residency or fellowship program.

Program Evaluation: Systematic collection and analysis of information related to the design, implementation, and outcomes of a GME program, for the purpose of monitoring and improving its quality and effectiveness.

Program Evaluation Committee (PEC): The committee appointed by the program director to conduct program review as needed and the annual program evaluation.

Program Information Form (PIF): Historically, the document completed by the program director in preparation for a site visit. This term is no longer used by the ACGME-I.

Program Letter of Agreement (PLA): A written document that addresses GME responsibilities between an individual accredited program and a site other than the primary clinical site at which residents/fellows receive a required part of their education. (See Foundational Program Requirements).

Program Merger: Two or more programs that combine to create a single program. One program may maintain Continued Accreditation while accreditation is Voluntarily Withdrawn from the other(s). Alternatively, both (all) programs may be withdrawn and a new program established. A site visit and program assessment by a Review Committee may be necessary following a program merger.

Program Year: Refers to the current year of a resident’s/fellow's education within a specific program; this designation may or may not correspond to the resident’s/fellow's graduate year level.

Required: Educational experiences within a residency/fellowship program designated for completion by all residents/fellows.

Resident: A physician in an ACGME-I-accredited GME specialty program.

Residency: A program accredited to provide a structured educational experience designed to conform to the Foundational and Advanced Specialty Requirements of a particular specialty.

Review Committee-International: The committee appointed by the ACGME-I Board of Directors and the Chief Executive Officer of ACGME-I to reviews accreditation standards and provides peer evaluation of Sponsoring Institutions and residency and fellowship programs. Members include physician specialists who represent major areas of graduate medical education (GME) and have significant experience in accreditation of GME institutions and programs. Members are from the United States and ACGME-I-accredited Sponsoring Institutions and programs.

Rotation: An educational experience of planned activities in selected settings, over a specific time period, developed to meet specific goals and objectives of the program.

Scheduled duty periods: Assigned activities within the institution encompassing hours which may be within the normal work day, beyond the normal work day, or a combination of both.

Scholarly Activity: An opportunity for residents/fellows and faculty members to participate in research or other forms of scholarship, such as organized clinical discussions, rounds, journal clubs, and conferences. Some members of the faculty should also demonstrate participation in scholarly activity 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, national, or international professional and scientific society meetings; or participation in national or international committees or educational organizations. (See Foundational Program Requirements).

Self-study: An objective, comprehensive self-evaluation of a residency or fellowship program, with the aim of improving it, conducted ahead of an accreditation site visit. Underlying the self-study is a longitudinal evaluation of the program and its learning environment, facilitated through sequential annual program evaluations that focus on the requirements and emphasize program strengths and self-identified areas for improvement.

Short Call: Responsibility for admitting patients to the teaching service during the early part of the day. Residents/fellows begin call in the morning, admit patients until some designated time in the afternoon or late morning, and do not stay in the hospital overnight.

Should: A term used to designate requirements so important that their absence must be justified. A program or institution may be cited for failing to comply with a requirement that includes the term ‘should.’

Site: An organization providing educational experiences or assignments/rotations for residents/fellows.

Site Director: The faculty member at a participating site who is responsible for the administration of the educational program at that site, including assessment of residents/fellows and oversight of the policies and procedures that govern resident/fellow education during their assignment at the site.

Site Visit: A site visit addresses and assesses compliance with all applicable requirements and encompasses all aspects of a Sponsoring Institution or program. Site visits are scheduled to residency programs applying for Initial Accreditation, to programs and Sponsoring Institutions moving from Initial to Continued Accreditation, or following completion of a self-study. Site visits can be also scheduled following the annual review of a program where the Review Committee International seeks additional information prior to making an annual accreditation decision or to investigate a complaint against a program or Sponsoring Institution.

Specialty Program: See Advanced Specialty Program.

Sponsoring Institution: The organization (or entity) that assumes the ultimate financial and academic responsibility for a GME program. The sponsoring institution has the primary purpose of providing educational programs and/or health care services (e.g., a university, a medical school, a hospital, a school of public health, a health department, a public health agency, an organized health care delivery system, a medical examiner’s office, a consortium, or an educational foundation).

Strategic napping: Short sleep periods, taken as a component of fatigue management, that can mitigate the adverse effects of sleep loss.

Subspecialty Program: A structured educational experience following completion of a prerequisite specialty/core program in GME designed to conform to the Advanced Specialty Requirements of a particular subspecialty area. The subspecialty program functions in conjunction with an accredited specialty/core program, sponsored by the same sponsoring institution, and in geographic proximity to the core program (also called a 'fellowship').

Summative Evaluation: Assessment with the primary purpose of establishing whether or not performance measured at a single defined point in time meets established performance standards, permanently recorded in the form of a grade or score. Also determines the successful completion an educational program.

Supervising Physician: A physician (faculty member, more senior resident, or fellow) designated by the program director as the supervisor of a junior resident. Such designation must be based on the demonstrated medical and supervisory capabilities of the physician.

Supervision Levels: To ensure oversight of resident/fellow supervision and graded authority and responsibility, the program must use the following classification of supervision:

Direct Supervision:
The supervising physician is physically present with the resident/fellow and patient.

Indirect Supervision:
(1) With direct supervision immediately available – The supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision.
(2) With direct supervision available – The supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.

Oversight:
The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Transfer resident: Residents are considered “transfer residents” under several conditions, such as: moving from one program to another within the same or different sponsoring institution; and when entering a PGY-2 program requiring a preliminary year, even if the resident was simultaneously accepted into the preliminary PGY-1 program and the PGY-2 program as part of the match (e.g., accepted to both programs right out of medical school). Before accepting a transfer resident, the program director of the receiving program must obtain written or electronic verification of previous educational experiences and a summative competency-based performance evaluation from the current program director. The term ‘transfer resident’ and the responsibilities of the two program directors noted above do not apply to a resident who has successfully completed a residency and is then accepted into a subsequent residency or fellowship program.

Transitional Year Program: A one-year educational experience in GME structured to provide a program of multiple clinical disciplines; designed to facilitate the choice of and/or preparation for a specialty.

Transitions of care: The relaying of complete and accurate patient information between individuals or teams in transferring responsibility for patient care in the health care setting.

Withdrawal of Accreditation: A status that is conferred when a Review Committee determines that a Sponsoring Institution or program fails to demonstrate substantial compliance with the Requirements.

Accreditation with Warning: A status that is conferred when a Review Committee determines that a Sponsoring Institution or program fails to demonstrate substantial compliance with several requirements that may jeopardize its future accreditation status.