The ACGME Self-Study—An Opportunity, Not a Burden

Abstract

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented the Next Accreditation System.1 A major goal of the new system is for program accreditation to become a continuous process of quality improvement. Accredited residency and fellowship programs report specified data annually to the ACGME. These data are then reviewed by the specialty review committees for compliance with each specialty's requirements. The newest component of this process is the self-study.The self-study is a new and evolving approach to residency and fellowship accreditation. Although a self-study has been used by many educational accreditors, it has not been used in graduate medical education. The ACGME now requires programs, as a part of their 10-year review cycle, to perform a self-study.2,3Why is this a challenge for programs? This is a new process and tested models are lacking. The approach used by the Liaison Committee for Medical Education is time-consuming and not truly applicable to a graduate medical education program, as it is a much smaller unit of analysis compared to a medical school. To date, there are no templates or sample documents available, nor have any seminars or workshops been presented by representatives from programs that have done this successfully. Programs need to “start from scratch,” and this is not an easy task. Additionally, the more time programs spend on developing a new process, the less time they may have to actually perform the self-study.The purpose of this article is to provide an example of a successful self-study process, along with a sample timeline and self-study materials. This will hopefully guide other programs through the process, and decrease the time spent on developing a new self-study process. Ultimately, this should allow more time to be spent on the performance of a rich and informative self-study.Programs are notified approximately 6 to 7 months prior to their self-study submission date.The self-study process requires the key steps shown in box 1.Engagement of key stakeholders is essential, as is an organized and facile process. If several programs are being reviewed together (core specialty and subspecialty programs), representatives from all programs should work together to develop a unified and logical self-study process, as well as to identify shared needs, and resources to meet these needs. It does not make sense for each program to create a parallel process, as such a duplicate effort wastes valuable time and other resources. Additionally, broad engagement in the process by those with diverse knowledge and experience may result in a richer outcome than might occur with 1 program alone. box 2 shows key considerations for the self-study process.It is important to note that the self-study summary document to be submitted to the ACGME does not include information on program strengths and areas for improvement. This is to encourage programs to honestly address problems, concerns, and faults in their self-study process without fear of a negative accreditation outcome. For the program's 10-year accreditation site visits, scheduled 12 to 18 months after the self-study, the program is asked to submit a list of program strengths, and a summary of the improvements and achievements that were made in areas that were identified during the self-study.Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; SWOT, strengths, weaknesses, opportunities, threats.A list of key action items for the self-study is provided in box 3. The first step should be to recruit a Self-Study Planning Committee. A relatively small representative group is recommended for this stage in the process. Members should be dependable, informed, and creative, with excellent teamwork skills. Organization and efficiency are essential.This committee will draft a process for the larger program leadership group to review and modify as needed. Program individualization will take place once the core self-study process is defined. It is recommended that the committee use a shared document folder (eg, cloud-based, internal server–based), where documents can be uploaded, shared, and modified by committee members throughout the process.Box 4 shows a sample timeline for a large internal medicine (IM) core program and its subspecialty programs. The timeline is planned by design to ensure a finite time commitment during each phase of the process, including the time to obtain stakeholder input and validation. The self-study for a stand-alone core program, or smaller groups of subspecialties along with the core, will likely require less time, and may not require a separate planning committee.Many residency and fellowship programs do not have their first self-study scheduled for several years. These programs will benefit from enhancing their required annual program evaluation with review of program aims (box 5). A SWOT (strengths, weaknesses, opportunities, threats) analysis that takes into consideration the environmental context in which the program operates adds an assessment of opportunities and threats to the review of strengths and areas for improvement.The web supplemental information for this article includes a selection of useful tools for the self-study. The tools are listed below: