The ACGME accreditation system is designed to encourage excellence and innovation in graduate medical education regardless of the organizational affiliation, size, or location of the program.

The educational program must support the development of knowledgeable, skillful physicians who provide compassionate care.

In addition, the program is expected to define its specific program aims consistent with the overall mission of its Sponsoring Institution, the needs of the community it serves and that it graduates will serve, and the distinctive capabilities of physicians it intends to graduate. While programs must demonstrate substantial compliance with the Common and specialty-specific Program Requirements, it is recognized that within this framework, programs may place difference emphasis on research, leadership, public health, etc. It is expected that the program aims will reflect the nuanced program-specific goals for it and its graduates; for example, it is expected that a program aiming to prepare physician-scientists will have a different curriculum from one focusing on community health.

IV.A. The curriculum must contain the following educational components:

IV.A.1. a set of program aims consistent with the Sponsoring Institution's mission, the needs of the community it serves, and the desired distinctive capabilities of its graduates; (Core)

I.V.A.1.a) The program's aims must be made available to program applicants, residents, and faculty members. (Core)

IV.A.2. competency-based goals and objectives for each educational experience designed to promote progress on a trajectory to autonomous practice. These must be distributed, reviewed, and available to residents and faculty members; (Core)

Background and Intent

The trajectory to autonomous practice is documented by Milestones evaluation. The Milestones detail the progress of a resident in attaining skill in each competency domain. They are developed by each specialty group and allow evaluation based on observable behaviors. Milestones are considered formative and should be used to identify learning needs. This may lead to focused or general curricular revision in any given program or to individualized learning plans for any specific resident.

IV.A.3. delineation of resident responsibilities for patient care, progressive responsibility for patient management, and graded supervision; (Core)

Background and Intent

These responsibilities may generally be described by PGY level and specifically by Milestones progress as determined by the Clinical Competency Committee. This approach encourages the transition to competency-based education. An advanced learner may be granted more responsibility independent of PGY level and a learner needing more time to accomplish a certain task may do so in a focused rather than global manner.

IV.A.4. a broad range of structured didactic activities, (Core)

IV.A.4.a) Residents must be provided with protected time to participate in core didactic activities. (Core)

Background and Intent

It is intended that residents will participate in structured didactic activities. It is recognized that there may be circumstances in which this is not possible. Programs should define core didactic activities for which time is protected and the circumstances in which residents may be excused from these didactic activities. Didactic activities may include, but are not limited to, lectures, conferences, courses, labs, asynchronous learning, simulations, drills, case discussions, grand rounds, didactic teaching, and education in critical appraisal of medical evidence.

IV.A.5. advancement of residents knowledge of ethical principles foundational to medical professionalism; and, (Core)

IV.A.6. advancement in the residents' knowledge of the basic principles of scientific inquiry, including how research is designed, conducted, evaluated, explained to patients, and applied to patient care. (Core)

Background and Intent

The Competencies provide a conceptual framework describing the required domains for a trusted physician to enter autonomous practice. These Competencies are core to the practice of all physicians, although the specifics are further defined by each specialty. The developmental trajectories in each of the Competencies are articulated through the Milestones for each specialty.

IV.B.1. The program must integrate the following ACGME competencies into the curriculum: (Core)

IV.B.1.a) Professionalism
	Residents must demonstrate a commitment to professionalism and an adherence to ethical principles. (Core) IV.B.1.a).(1) Residents must demonstrate competence in: IV.B.1.a).(1).(a) compassion, integrity, and respect for others; (Core) IV.B.1.a).(1).(b) responsiveness to patient needs that supersedes self-interest; (Core) Background and Intent This includes the recognition that under certain circumstances, the interests of the patient may be best served by transitioning care to another provider. Examples include fatigue, conflict or duality of interest, not connecting well with a patient, or when another physician would be better for the situation based on skill set or knowledge base. IV.B.1.a).(1).(c) respect for patient privacy and autonomy; (Core) IV.B.1.a).(1).(d) accountability to patients, society, and the profession; (Core) IV.B.1.a).(1).(e) respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation; (Core) IV.B.1.a).(1).(f) ability to recognize and develop a plan for one's own personal and professional well-being; and, (Core) IV.B.1.a).(1).(g) appropriately disclosing and addressing conflict or duality of interest. (Core)
IV.B.1.b) Patient Care and Procedural Skills
	Background and Intent Quality patient care is safe, effective, timely, efficient, patient-centered, equitable and designed to improve population health, while reducing per capita costs. (See the Institute of Medicine (IOM)'s Crossing the Quality Chasm: A New Health System for the 21st Century, 2001 and Berwick D, Nolan T, Whittington J. The Triple Aim: care, cost, and quality. Health Affairs. 2008; 27(3):759-769.) In addition, there should be a focus on improving the clinician's well-being as a means to improve patient care and reduce burnout among residents, fellows, and practicing physicians. These organizing principles inform the Common Program Requirements across all Competency domains. Specific content is determined by the Review Committees with input from the appropriate professional societies, certifying boards, and the community. IV.B.1.b).(1) Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. (Core) The Review Committee must further specify. IV.B.1.b).(2) Residents must be able to perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. (Core) The Review Committee must further specify.
IV.B.1.c) Medical Knowledge
	Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. (Core) The Review Committee must further specify.
IV.B.1.d) Practice-based Learning and Improvement
	Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. (Core) Background and Intent Practice-based learning and improvement is one of the defining characteristics of being a physician. It is the ability to investigate and evaluate the care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning. The intention of this Competency is to help a physician develop the habits of mind required to continuously pursue quality improvement, well past the completion of residency. IV.B.1.d).(1). Residents must demonstrate competence in: IV.B.1.d).(1).(a) identifying strengths, deficiencies, and limits in one's knowledge and expertise; (Core) IV.B.1.d).(1).(b) setting learning and improvement goals; (Core) IV.B.1.d).(1).(c) identifying and performing appropriate learning activities; (Core) IV.B.1.d).(1).(d) systematically analyzing practice using quality improvement methods, and implementing changes with the goal of practice improvement; (Core) IV.B.1.d).(1).(e) incorporating feedback and formative evaluation into daily practice; (Core) IV.B.1.d).(1).(f) locating, appraising, and assimilating evidence from scientific studies related to their patients' health problems; and, (Core) IV.B.1.d).(1).(g) using information technology to optimize learning. (Core) The Review Committee may further specify by adding to the list of sub-competencies
IV.B.1.e) Interpersonal and Communication Skills
	Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. (Core) IV.B.1.e).(1) Residents must demonstrate competence in: IV.B.1.e).(1).(a) communicating effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; (Core) IV.B.1.e).(1).(b) communicating effectively with physicians, other health professionals, and health-related agencies; (Core) IV.B.1.e).(1).(c) working effectively as a member or leader of a health care team or professional group; (Core) IV.B.1.e).(1).(d) educating patients, families, students, residents, and other health professionals; (Core) IV.B.1.e).(1).(e) acting in a consultative role to other physicians and health professionals; and, (Core) IV.B.1.e).(1).(f) maintaining comprehensive, timely, and legible medical records, if applicable. (Core) IV.B.1.e).(2) Residents must learn to communicate with patients and families to partner with them to assess their care goals, including, when appropriate, end-of-life goals. (Core) The Review Committee may further specify by adding to the list of sub-competencies. Background and Intent When there are no more medications or interventions that can achieve a patient's goals or provide meaningful improvements in quality or length of life, a discussion about the patient's goals, values, and choices surrounding the end of life is one of the most important conversations that can occur. Residents must learn to participate effectively and compassionately in these meaningful human interactions for the sake of their patients and themselves. Programs may teach this sill through direct clinical experience, simulation, or other means of active learning.
IV.B.1.f) Systems-based Practice
	Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, including the social determinants of health, as well as the ability to call effectively on other resources to provide optimal health care. (Core) Residents must demonstrate competence in: IV.B.1.f).(1) Residents must demonstrate competence in: IV.B.1.f).(1).(a) working effectively in various health care delivery settings and systems relevant to their clinical specialty; (Core) Background and Intent Medical practice occurs in the context of an increasingly complex clinical care environment where optimal patient care requires attention to compliance with external and internal administrative and regulatory requirements. IV.B.1.f).(1).(b) coordinating patient care across the health care continuum and beyond as relevant to their clinical specialty; (Core) Background and Intent Every patient deserves to be treated as a whole person. Therefore it is recognized that any one component of the health care system does not meet the totality of the patient's needs. An appropriate transition plan requires coordination and forethought by an interdisciplinary team. The patient benefits from proper care and the system benefits from proper use of resources. IV.B.1.f).(1).(c) advocating for quality patient care and optimal patient care systems; (Core) IV.B.1.f).(1).(d) working in interprofessional teams to enhance patient safety and improve patient care quality; (Core) IV.B.1.f).(1).(e) participating in identifying system errors and implementing potential systems solutions; (Core) IV.B.1.f).(1).(f) incorporating considerations of value, cost awareness, delivery and payment, and risk-benefit analysis in patient and/or population-based care as appropriate; and, (Core) IV.B.1.f).(1).(g) understanding health care finances and its impact on individual patients' health decisions. (Core)