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Plastic Surgery Resident Letter
Dear Resident Applicant: You have spent a great deal of time and energy preparing yourself for the next stage of your medical education. As you begin collecting information about residency programs, I would urge you to spend a moment to read this letter and perhaps a few more pages to become a more sophisticated consumer as you begin "shopping" for a residency. Determining which programs to apply to leads to the inevitable question: "How can I tell if this is a good program?" Wouldn't it be great if there were Consumer Reports for residencies? It may surprise you to know that information exists in the form of accreditation status. "Accreditation represents a professional judgement about the quality of an educational program. 1 However, it is difficult to interpret that information without some understanding of the accreditation process and the standards by which all programs are judged. The purpose of this communication is to provide you with fundamental knowledge of the accreditation process and to inform you of your rights as a resident and the responsibilities of the institution sponsoring your residency. All of this is under the auspices of the Accreditation Council for Graduate Medical Education (ACGME). The ACGME is essentially a regulatory agency to oversee accreditation of graduate medical education/residency programs. The ACGME takes a dual approach to accreditation. It reviews the institution (e.g. hospitals, medical schools, clinics, etc.) sponsoring the residency program and it accredits individual residency programs. The ACGME has designated an institutional review committee (IRC) to establish and enforce institutional requirements and a residency review committee (RRC) to establish and enforce program requirements. There is a separate RRC for each specialty, which consists of an executive director from the ACGME, practitioners of that specialty, as well as one resident representative. The accreditation process determines whether an educational program is in compliance with established educational standards as set forth in the institutional and program requirements. Based upon the composition of the RRCs, accreditation should be considered a peer review process to determine whether or not residency programs are successful in fulfilling these requirements. At this point, you may be wondering what any of this has to do with you. As good citizens, we all know about local, state, and federal forms of government. As residents, the residency program, sponsoring institution, and ACGME are correspondingly analogous to local, state and federal government. It is important to appreciate this framework in which all residents and residencies function. Just as the federal government assures the freedom of its citizens, the ACGME also functions to protect the rights of residents. The competitive nature of obtaining a residency position, the long hours spent training, and the increasing complexity of patient care all contribute to the potential for adverse resident conditions. Institutions that sponsor graduate medical education must create an environment conducive to resident education. Accordingly, "sponsoring institutions must provide services and develop systems to minimize the work of residents that is extraneous to their educational programs" as outlined in the institutional requirements. Failure to do so jeopardizes the accreditation status of all residency programs sponsored by the institution. The institutional requirements are very relevant to you as an individual because they address critical issues such as: resident support, benefits, conditions of employment, due process for resident dismissal, and policies for addressing resident complaints such as sexual harassment. Each sponsoring institution is also required to have a graduate medical education committee (GMEC), with resident representation, which serves as an interface between the residents and the institution. The GMEC can address general resident issues and individual complaints under special circumstances. See the ACGME website at www.acgme.org for more information regarding adjudication of individual resident complaints within the context of the residency, the institution, and the ACGME. In essence, the institutional requirements contain the residents' Bill of Rights. They can be found at the ACGME website and in the Graduate Medical Education Directory (also known as "the green book") in "Section II - Essentials of Accredited Residencies in Graduate Medical Education: Institutional and Program Requirements." The institutional requirements are only four pages long and yield substantial information regarding your rights as a resident and the responsibilities of the sponsoring institution. While the Institutional Requirements provide the basic foundation for all residencies, the program requirements define the educational objectives and policies specific for each specialty. The program requirements for each specialty can also be found at the ACGME website and in the green book in "Section II - Essentials of Accredited Residencies in Graduate Medical Education: Institutional and Program Requirements" and are generally about five pages long. There are two important benefits derived from reading the program requirements: you comprehend the required functions of your residency program and the standards programs must meet to attain full accreditation. Let's get more concrete about what this means. Prior to heading out on the interview trail you should obtain information regarding the accreditation status of programs you are interested in (never assume anything) before spending your precious cash to go interview at a program that is on probation. This information can now be obtained at the ACGME website at www.acgme.org. The accreditation status of an established program is either full accreditation or probation. Programs placed on probation are required to notify all residents and resident applicants of the change in accreditation to probationary status. New programs are granted provisional accreditation and reviewed twice over a five to six-year period. If the program fails to achieve substantial compliance with the program requirements within that time frame, then accreditation of the program is withdrawn and you may have to go elsewhere to finish your training. Occasionally, even a good program can lapse into probation, as accreditation requires strict compliance with all aspects of the program requirements. If this is the case for a program in which you have a strong interest, it may still be worthwhile to interview there. During your interview with the program director be very frank and ask why the program is on probation. If you have read the program requirements, you will have better insight regarding the strengths and weaknesses of a program allowing you to make more informed decisions. The last important piece of information to pass along has to do with resolution of conflicts. There are thousands of residents and hundreds of program directors across the country. It is inevitable that conflicts will arise. The vast majority of residents will never experience significant conflicts regarding their training, but when it does happen, residents typically don't know how to respond or where to seek help. Residents end up feeling frustrated and isolated. Fear of retribution from confronting a program director prevents residents from responding to decisions or actions they perceive as unfair. The institutional and program requirements are designed to ensure the educational quality of training programs and ensure the welfare of the residents. They do this by requiring due process and allowing you to appeal decisions that affect you adversely. The common perception is that residency programs are autocratic, with decisions from the program directors as final word. In reality, individual residency programs are local governing units to be viewed as part of a republic linked together by adherence to common program and institutional requirements regulated by the RRC and ACGME. This is an important and empowering paradigm shift, because it gives you options when confronted with unfavorable circumstances (go to the ACGME website and click on ACGME Information for more details). To those of you who are still in medical school, this information may seem nebulous, but its meaning will become clear once you are immersed in your residency. Remember, ignorance makes you susceptible to unfair treatment. Working knowledge of the institutional and program requirements is like understanding the legal codes and enables you to be a better advocate for yourself and your fellow residents. Hopefully you will never need this information, but now you know where to get help is you need it. I wish you success in starting the next phase of your career. Sincerely, Gayle Gordillo, M.D. Resident Member, Residency Review Committee for Plastic Surgery 1Graduate Medical Education Directory 1998-1999, 83rd ed., p 26, 1998. American Medical Association Medical Education Products, Chicago, IL 60654 |
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