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Report from the Residency Review Committee for Physical Medicine and Rehabilitation:

The New Institutional Requirements
Gerald Felsenthal, MD, Chairman
Residency Review Committee for Physical Medicine and Rehabilitation

New Institutional Requirements went into effect as of July 1997. The Program Requirements for Physical Medicine and Rehabilitation (PMR) state that "all provisions of the Institutional Requirements must also be met for accreditation." This article will review selected sections of the Institutional Requirements that program directors should be cognizant of, as they are integral to the PMR Program Requirements as well.

Section IB3 lists the responsibilities of the institution's Graduate Medical Education Committee (GMEC). Item b emphasizes the reestablishment and maintenance of appropriate oversight of and liaison with program directors and assurance that program directors establish and maintain proper oversight of and liaison with appropriate personnel of other institutions participating in programs sponsored by the institutions.

In the same section, item c addresses the need for "regular review of all residency programs (by the GMEC) to assess their compliance with both the Institutional Requirements and Program Requirements of the relevant ACGME review committees." The composition of the GMEC is given and the component parts of the review are listed, including materials to be reviewed. Annual departmental reports are not a satisfactory substitute. Most importantly, the review must be conducted between the ACGME surveys, and the RRC for PMR prefers that the interim review be midway between its RRC surveys.

The same section states in items g and h that the GMEC must monitor the program in establishing an appropriate work environment and duty hours for residents. Also, the resident's curriculum must provide a "regular review of ethical, socioeconomic, medical/legal, and cost-containment issues that affect GME and medical practice. The curriculum must also provide an appropriate introduction to communication skills and to research design, statistics, and critical review of the literature necessary for acquiring skills for lifelong learning. There must be appropriate resident participation in departmental scholarly activity, as set forth in the applicable Program Requirements."

Section IE1 addresses quality assurance and states that "all residents should receive instruction in quality assurance/performance improvement. To the degree possible and in conformance with state law, residents should participate in appropriate components of the institution's performance improvement program."

Section IIA1 addresses resident eligibility. The rules indicate the eligibility requirements for graduates of Liaison Committee on Medical Education (LCME) or American Osteopathic Association accredited medical or osteopathic schools. Qualifications for graduates of medical schools outside the United States and Canada are given, including fifth pathway programs.

There is no allowance for graduates of non LCME accredited medical schools in the United States or Canada. Section IIA3 states that "the enrollment of non-eligible residents may be a cause for withdrawal of accreditation of the involved program."

Section IIB addresses resident participation in educational activities. "Institutions must ensure that residents have the opportunity to:

1 . develop a personal program of learning to foster continued professional growth with guidance from the teaching staff;

2. participate in safe, effective, and comprehensive patient care, under supervision, commensurate with their level of advancement and responsibility;

3. participate fully in the educational and scholarly activities of their program and, as required, assume responsibility for teaching and supervising other residents and students;

4. participate as appropriate in institutional programs and medical staff activities and adhere to established practices, procedures, and policies of the institution;

5. have appropriate representation on institutional committees and councils whose actions affect their education and/or patient care; and

6. submit to the program director, at least annually, confidential written evaluations of the faculty and of the educational experiences."

Section IID addresses resident supervision, duty hours, and work environment. Appropriate supervision of residents by the teaching staff is emphasized. Supervision should allow residents to "assume progressively increasing responsibilities (as determined by the teaching staff) according to their level of education, ability, and experience." Teaching staff must ensure that supervision is available to residents on duty. "The structuring of duty hours and on-call schedules must focus on the needs of the patient, continuity of care, and the educational needs of the resident. Duty hours must be consistent with the Institutional and Program Requirements that apply to each program."

These are selected items taken from the new Institutional Requirements. It is recommended that each program director get a copy of these requirements and ensure that his/her training program is in compliance.

Copies can be obtained directly from the ACGME WebSite at http://www.acgme.org then click on "Institutional Review" then "Download IRD"

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