Few Important Things to know: November 2010

ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION

GLOSSARY OF TERMS

September 29, 2010

  ACGME 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, standards
and following a prescribed process, performed by a non-governmental agency of peers.

Applicant: An M.D. or D.O. invited to interview with a GME program.

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

At-Home Call: Same as 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 the resident’s one free day per week (averaged over four weeks).

Attending Physician: An appropriately credentialed and privileged member of the medical staff
who accepts full responsibility for a specific patient’s medical/surgical care.

Categorical Resident (also see “Graduate Year 1"): A resident who enters a program with 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.

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

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 policy or procedure.

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 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 the RRCs before inclusion in their respective program requirements.
Clinical Supervision: A required faculty activity involving the oversight and direction of patient
care activities that are provided by residents/fellows.

Combined Specialty Programs: Programs recognized by two or more separate specialty
boards to provide GME in a particular combined specialty. Each combined specialty program is
made up of two or three programs, accredited separately by the ACGME at the same institution.

  2Common Program Requirements: The set of ACGME requirements that apply to 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 of residents or fellows approved by a Residency Review
Committee per year and/or per program based upon availability of adequate 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 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.

Consortium: An association of two or more organizations, hospitals, or institutions that have
come together to pursue common objectives (e.g., GME).

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

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 on 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 (DIO): 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 by means of planned learning experiences, such as
conferences 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. Hurricane Katrina is an example of a
disaster.

Duty Hours: Duty hours are defined as all clinical and academic activities related to the
program; i.e., 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.

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.

  3Elective: An educational experience approved for inclusion in the program curriculum and
selected by the resident in consultation with the program director.

Essential: (See "Must")

External moonlighting: Voluntary, compensated, medically-related work performed outside
the institution where the resident is in training or at any of its related participating sites.

Extreme Emergent Situation: A local event (such as a hospital-declared disaster for an
epidemic) that affect resident education or the work environment but does not rise to the level of
an ACGME-declared disaster as defined in the ACGME Policies and Procedures, Section
25.20.

Faculty: Any individuals who have 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 or supervisor of a level of resident
fatigue that may adversely affect patient safety and enactment of a solution to mitigate the
fatigue.

Fellow: A physician in a 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 1 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 an ACGME-accredited residency as an international medical
graduate.

Fitness for duty: Mentally and physically able to effectively perform required duties and
promote patient safety.

Focused Institutional Site Visit: An 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.

  4Graduate Medical Education: The period of didactic and clinical education in a medical
specialty which follows the completion of a 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 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.
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, a
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 3 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 in the assigned institution.

Innovation: Experimentation initiated at the program level which may involve an individual
program, a group of residents (e.g., PGY1 residents) or an individual resident (e.g., chief
resident).

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

Integrated: A 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 of residents, and c) 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 is no longer
used by the ACGME.

Internal Moonlighting: Voluntary, compensated, medically-related work (not related with
training requirements) performed within the institution in which the resident is in training or at
any of its related participating 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 (IMG): A graduate from a medical school outside the United
States and Canada (and not accredited by the Liaison Committee on 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.

  5JC: 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 to 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 a major participating site.

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

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 to 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 to 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 or 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 to provide programs and institutions with additional resources for resident
education. Notable practices do not create additional requirements for programs or 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 be applied to individual learning, courses, programs, institutions,
and systems, in repeated cycles.

Pilot: An ACGME-approved project, which is initiated by the Review Committee and involves
several residency/fellowship programs that elect to participate.
  6
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 or
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
in 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 PIF is the document completed by the program director
in preparation for a site-visit. The document is a compilation of requested information that
reflects the current status of the educational program. The PIF 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 PIF, which addresses compliance with
the specialty or subspecialty specific program requirements. The Common PIF is electronically
generated through the Accreditation Data System.

Program Letter of Agreement (PLA): A written document that addresses GME responsibilities
between an individual accredited program and a site other than the sponsoring institution at
which residents receive a required part of their education.

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 program or programs. Alternatively, both programs may be withdrawn and a new
program may be established.

Program Year: Refers to the current year of education within a specific program; this
designation may or may not correspond to 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 to provide a structured educational experience designed to
conform to the Program Requirements of a particular specialty.
  7
Rotation: An educational experience of planned activities in selected settings, over a specific
time period, developed to meet goals and objectives of the program.

Scheduled duty periods: Assigned duty 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 to participate in research,
as 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
in national committees or educational organizations. (See Common Program Requirements)

Shall: (See must)

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 educational assignments/rotations
for residents/fellows.

Major Participating Site: A Review Committee-approved site to which all residents in at
least one program rotate for a required educational experience, and for which a master
affiliation agreement must be in place. To be designated as a major participating site in a
two-year program, all residents must spend at least four months in a single required rotation
or a combination of required rotations across both years of the program. In programs of
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 of 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, a
medical school, a teaching hospital which includes its ambulatory clinics and related
facilities, a private medical practice 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 health maintenance organization (HMO), a medical
examiner’s 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 of a particular specialty; also known as ‘core’
programs.

  8Sponsoring Institution: The organization (or entity) that assumes the ultimate financial and
academic responsibility for a program of GME. 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, 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).

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

Subspecialty Program: A structured educational experience following completion of a
prerequisite specialty program in GME designed to conform to the Program Requirements of a
particular subspecialty.

Dependent Subspecialty Program: A program that is required to function in conjunction
with an accredited specialty/core program, usually reviewed conjointly with the specialty
program, usually sponsored by the same sponsoring institution, and geographically
proximate. The continued accreditation of the subspecialty program is dependent on the
specialty program maintaining its accreditation.

Independent Subspecialty Program: A program that is not directly related to, or
dependent upon, the accreditation status of a specialty program.

Suggested: A term along with its companion “strongly suggested,” used to indicate that
something is distinctly urged rather than required. An institution or program will not be cited for
failing to do something that is suggested or strongly suggested.

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.

Supervising Physician: A physician, either faculty member or more senior resident,
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.

Transfer resident: Residents are considered as transfer residents under several conditions
including: moving from one program to another within the same or different sponsoring
institution; when entering a PGY 2 program requiring a preliminary year even if the resident was
simultaneously accepted into the preliminary PGY1 program and the PGY2 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 then is accepted into a subsequent residency or
fellowship program.

  9 10
Transitional-Year Program: A one-year educational experience in GME, which is structured to
provide a program of multiple clinical disciplines; its design to facilitate the choice of and/or
preparation for a specialty. The transitional year is not a complete graduate education program
in preparation for the practice of medicine.

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

AST-KM 7/30/2007
TSW 4/21/2008
TSW 8/7/2008
TSW 9/24/08
TSW 01/20/09
TSW 03/2009
TSW 09/18/2009
TSW 09/29/2010
COMMON ACRONYMS/ABBREVIATIONS USED IN GRADUATE MEDICAL EDUCATION

AAMC Association of American Medical Colleges
ABMS American Board of Medical Specialties
ACCME Accreditation Council for Continuing Medical Education
ACGME Accreditation Council for Graduate Medical Education
ADS Accreditation Data System
AHA American Hospital Association
AMA American Medical Association
AMA-CME American Medical Association – Council on Medical Education
CAAR Computer Assisted Accreditation Review
CBE Competency-Based Education
CMS Centers for Medicare and Medicaid Services
CMSS Council of Medical Specialty Societies
CRCC Council of Review Committee Chairs
CRCR Council of Review Committee Residents
DIO Designated Institutional Official
ECFMG Educational Commission for Foreign Medical Graduates
ERAS Electronic Residency Application Service
FREIDA Fellowship and Residency Interactive Database (AMA)
FS Accreditation Field Staff
FSMB Federation of State Medical Boards
GME Graduate Medical Education
HIPAA Health Insurance Portability and Accountability Act
IRC Institutional Review Committee
IRD Institutional Review Document
JC Joint Commission on Accreditation of Healthcare Organizations
LCME Liaison Committee on Medical Education
LON Letter of Notification
NBME National Board of Medical Examiners
PD Program Director
PDF Portable Document Format
PGY Post Graduate Year
PIF Program Information Form
PLA Program Letter of Agreement (for residency and fellowship program)
NRMP National Resident Matching Program
RC Review Committee
RQ Resident Questionnaire (used in Internal Medicine)
RRC Residency Review Committee
SV Site Visitor
SSV Specialist Site Visitor
TYRC Transitional Year Review Committee
USMLE United States Medical Licensing Examination

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