Glossary of Terms

Accreditation: A voluntary process of evaluation and review based on published requirements and following a prescribed process, performed by a non-governmental agency of peers. 

Accreditation Data System (ADS): A web-based software system to collect, organize, and maintain information for accreditation purposes, and a means of communication between ACGME-I and Sponsoring Institutions and programs. 

Accreditation Preparedness Assessment (APA) Visit: An exchange of information between a potential Sponsoring Institution and ACGME-I for purposes of facilitating an informed decision by both parties on whether to enter a contractual relationship for provision of ACGME-I accreditation services. This assessment is performed at the request of the Sponsoring Institution(s) or a governmental agency and conducted by an ACGME-I assessment team. (See ACGME-I Manual of Policies and Procedures, Subject: 5.00.) 

Accreditation status: The official decision made by a Review Committee based on its review and assessment of a Sponsoring Institution’s or program’s compliance with the applicable requirements. 

Advanced Specialty Program Requirements: International Advanced Specialty Program Requirements specify what programs must implement in terms of the educational infrastructure, and what they must demonstrate regarding the specialty-specific curriculum, resources, and experiences that are essential in the discipline. 

Adverse action: An accreditation decision (i.e., Accreditation Withheld, Probationary Accreditation, Withdrawal of Accreditation, and non-voluntary reduction in resident/fellow complement) resulting from a Review Committee’s determination of substantial non-compliance with the applicable Foundational and/or Advanced Specialty Requirements. Adverse actions are subject to appeal. 

Adverse event: A harmful or negative outcome caused by medical management (rather than underlying disease), and that may have prolonged hospitalization, produced a disability, or both. 

Alleged egregious event: The occurrence of an alleged accreditation violation affecting a Sponsoring Institution or program determined by the President and Chief Executive Officer (or designee) of ACGME-I to be of sufficient importance and urgency to require a rapid response. 

Applicant: A physician invited to interview for a position in a graduate medical education program. 

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

At-home call (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 a resident’s/fellow’s one free day per week (averaged over four weeks). 

Attending physician: The single identifiable physician ultimately responsible and accountable for an individual patient’s care, who may or may not be responsible for supervising residents or fellows. 

Categorical resident: A resident who enters a program that begins in the PGY-1 and has the objective of completing the entire program. 

Certification: The official attestation by a specialty certifying board of an individual physician’s knowledge and skills relative to the provision of high-quality care in a particular specialty or subspecialty, generally following successful completion of one or more examinations. ACGME-I does not provide certification services. 

Chief resident: An administrative leadership position for a physician either in the final year of a residency program (e.g., for surgery programs) or in the year following completion of residency (e.g., for internal medicine or pediatrics programs). 

Citation: A finding of a Review Committee that a Sponsoring Institution or program has failed to comply substantially with a particular accreditation requirement. 

Clarifying information: Information that may be requested of a program by a Review Committee before it makes its annual accreditation decision for that program. 

Clinical Competency Committee (CCC): A required body comprising three or more members of the active teaching faculty, including at least one core faculty member, that is advisory to the program director and reviews the progress of all residents or fellows in the program. 

Clinical and educational work hours: All clinical and academic activities related to the program: patient care (inpatient and outpatient); administrative duties relative to patient care; the provision for transfer of patient care; time spent on in-house call; time spent on clinical work done from home; and other scheduled activities, such as conferences. These hours do not include reading, studying, research done from home, and preparation for future cases. Formerly known as “duty hours.” 

Clinical supervision: A required faculty activity involving the oversight and direction of patient care activities provided by residents/fellows. 

Competencies: Specific knowledge, skills, behaviors, and attitudes that physicians must develop for independent and autonomous practice of a specialty or subspecialty. The six ACGME-I Core Competencies are Professionalism; Patient Care and Procedural skills; Medical Knowledge; Practice-Based Learning and Improvement; Interpersonal and Communication Skills; and Systems-Based Practice. 

Complaint: An allegation that a Sponsoring Institution or program is non-compliant with accreditation requirements. 

Complement: The number of residents/fellows in a program. ACGME-I approves a maximum complement per program based on availability of 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: Intended to be disclosed only to an authorized person. Information that is deemed confidential does not imply that the source of the evaluation is anonymous. 

Continued Accreditation: An accreditation status conferred when a Review Committee determines that a Sponsoring Institution or program has demonstrated substantial compliance with applicable requirements. 

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

Core faculty: See Foundational Requirement II.B.2. 

Core specialty: A field of medical practice that focuses on a specific set of patient care skills and a defined knowledge base. 

Cycle length: The interval between an accreditation action and the target date identified for the next site visit. 

Dependent subspecialty program: A program that is required to function in conjunction with an ACGME-I-accredited specialty program, usually reviewed conjointly with the specialty program, usually sponsored by the same Sponsoring Institution, and geographically proximate to the specialty program. The accreditation of a dependent subspecialty program is contingent on the accreditation of its affiliated core specialty program. 

Designated institutional official (DIO): The individual in a Sponsoring Institution who has the authority and responsibility for all of that institution’s ACGME-I-accredited programs. 

Didactic: Describes a planned, systematic, instructed learning experience, such as a conference, journal club, or grand rounds. 

Disaster: An event or set of events causing significant alteration to the residency/fellowship experience at one or more programs. 

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

Extraordinary circumstance: A situation or event that significantly alters the ability of a Sponsoring Institution and its program(s) to support resident/fellow education. If the President and Chief Executive Officer of ACGME-I, in consultation with the ACGME-I Board of Directors, determines that a Sponsoring Institution’s ability to support resident/fellow education has been significantly altered, the ACGME-I Extraordinary Circumstances policy shall be invoked. (See ACGME-I Manual of Policies and Procedures, Subject: 15.00.) 

Faculty: The collective body of physicians and non-physicians who have individually received a formal assignment to teach and supervise resident/fellow physicians in a program. 

Fellow: An individual enrolled in an ACGME-I-accredited subspecialty or sub-subspecialty program who has completed a residency program in a related specialty and/or a fellowship program in a related subspecialty. 

Fellowship: See “Subspecialty program” 

Final Evaluation: The required overall evaluation to be completed by the program director for every resident/fellow upon completion of the program and that must include verification that the resident or fellow is ready for independent practice in the specialty, subspecialty, or sub-subspecialty. May also be referred to as a “summative evaluation.” 

Fitness for duty: Describes that an individual is mentally and physically able to effectively perform required educational and work responsibilities and promote patient safety. 

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 performance standards. 

Foundational Program Requirements: The set of ACGME-I requirements that outlines the educational infrastructure needed for all specialty programs. 

Graduate medical education (GME): The period of medical education that follows the completion of recognized undergraduate medical education and that prepares physicians for the independent practice of medicine in a specialty, subspecialty, or sub-subspecialty area, also referred to as residency or fellowship education. May also be referred to as “post-graduate medical education (PGME).” 

Independent Subspecialty Program: A fellowship program that is not required to function with an ACGME-I-accredited residency program in its related specialty.  

In-house call: Clinical and educational work hours, beyond the scheduled workday, when residents/fellows are required to be immediately available within an assigned site, as needed, for clinical responsibilities. In-house call does not include night float, being on call from home, or regularly scheduled overnight duties. 

Institutional Review: The process undertaken by ACGME-I to determine whether a Sponsoring Institution offering graduate medical education programs is in substantial compliance with the Institutional Requirements. 

Integrated PGY-1: Twelve months of basic clinical skills education completed prior to advanced specialty rotations. The integrated PGY-1 is an option for specialties that require a broad-based clinical year prior to advanced specialty education. 

Intern: Historically, a designation for individuals in the first year of graduate medical education. This term is no longer used by ACGME-I. 

Interprofessional team: The physicians and other health care professionals, including dietitians, nurses, pharmacists, physical therapists, social workers, etc., as appropriate, assigned to the delivery of care for an individual patient. 

Letter of Notification (LON): The official communication from ACGME-I that states an action taken by a Review Committee. 

Medical School Affiliation: A formal relationship between a medical school and a Sponsoring Institution. 

Milestones: Description of performance levels residents and fellows are expected to demonstrate for skills, knowledge, and behaviors in the six Core Competency domains. “The Milestones” refers to a complete set or the overall ACGME-I Milestones framework; “milestone(s)” refers to individual items within a set. 

Mock Site Visit: A structured site visit by a specialist site visitor to provide an institution or program with an assessment of its readiness to be ACGME-I-accredited, based on submitted application materials and interviews with key individuals. The specialist site visitor’s report with recommendations is reviewed by the Review Committee-International, which provides a final report to the institution or program that indicates areas of non-compliance with ACGME-I requirements, and/or suggestions for improvement. The Mock Site Visit is an educational activity requested by the entity seeking accreditation and does not influence the entity’s formal Initial Accreditation review. 

Must: A term used to identify a requirement that is mandatory or done without fail. This term indicates an absolute requirement. 

Night float: A rotation or educational experience designed either to eliminate in-house call or to assist other residents/fellows during the night. Residents/fellows assigned to night float are assigned on-site duty during evening/night shifts, are responsible for admitting or cross-covering patients until morning, and do not have daytime assignments. Such a rotation must have an educational focus. 

One day off: One 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 an institution. 

Pager call: See “At-home call” 

Participating site: An organization providing educational experiences or educational assignments/rotations for residents/fellows. Examples include a university, a medical school, a teaching hospital which includes its ambulatory clinics and related facilities, a private medical or group practice, a nursing home, a school of public health, a health department, a public health agency, an organized health care delivery system, a consortium, or an educational foundation. 

Patient safety event: An event, near miss, or other event resulting from unsafe conditions in the clinical care setting that could have affected or did adversely affect a patient(s). 

Post-graduate medical education (PGME): See “Graduate medical education (GME)” 

Post-Graduate Year (PGY): Refers to a resident's/fellow's current year of accredited graduate medical education (GME). This designation may or may not correspond to the resident’s/fellow’s particular year in a program. For example, a pediatric cardiology resident could be in the first program year of the pediatric cardiology program but in the fifth year of GME.  

Preliminary positions: Positions for residents who, at the time of admission to a program, have not been accepted into any specialty program. Note: preliminary positions are permitted only in ACGME-I-accredited programs in general surgery and internal medicine. 

Primary clinical site: The most used facility designated for clinical instruction in a program. 

Program coordinator: The lead administrative staff person who assists the program director in accreditation efforts, educational programming, and support of residents/fellows. 

Program director: The individual designated with authority and accountability for the operation of a graduate medical education program, including compliance with all applicable program requirements. 

Program evaluation: Systematic collection and analysis of information related to the design, implementation, and outcomes of a graduate medical education program, for the purpose of monitoring and improving its quality and effectiveness. 

Program Evaluation Committee (PEC): The group appointed by the program director to conduct program review as needed and as part of the Annual Program Evaluation. 

Program Letter of Agreement (PLA): A written document that addresses graduate medical education responsibilities between an individual accredited program and a site other than the primary clinical site at which residents/fellows receive a required part of their education. (See Foundational Program Requirement I.B.1.) 

Program year: Refers to the current year of a resident’s/fellow's education within a specific program; this designation may or may not correspond to the resident’s/fellow's graduate year level. 

Progress report:  An update on the steps taken by a Sponsoring Institution or program to address its citations, submitted in response to a request by a Review Committee.  

Required assignment: An educational experience designated for completion by all residents/fellows in a program. 

Resident: A physician in an ACGME-I-accredited specialty program. 

Residency: See “Specialty program” 

Review Committees-International: The groups of volunteers that establish and review accreditation standards (requirements) and provide peer evaluation of Sponsoring Institutions and programs. Members include physician specialists who have significant experience in accreditation of graduate medical education institutions and programs, as well as non-physician public representatives. Members are from the US and from ACGME-I-accredited Sponsoring Institutions and programs. 

Scholarly activity: Participation in research or other forms of scholarship, such as organized clinical discussions, rounds, journal clubs, and conferences. (See Foundational Requirement IV.D.) 

Self-Study: An objective, comprehensive self-evaluation of a residency or fellowship program, with the aim of improvement, conducted ahead of an accreditation site visit. Underlying the Self-Study is a longitudinal evaluation of the program and its learning environment, facilitated through annual program evaluations that focus on the requirements and emphasize program strengths and self-identified areas for improvement. (See the Foundational Requirements and Self-Study page of the ACGME-I website for more details.) 

Should: A term used to designate a requirement so important that its absence must be justified.  

Site director: The faculty member at a participating site who is responsible for the administration of the educational program at that site, including assessment of residents/fellows and oversight of the policies and procedures that govern resident/fellow education during their assignment at the site. 

Site visit: A visit by a professionally trained Accreditation Field Representative (also referred to as a site visitor) to evaluate a Sponsoring Institution or program. The Field Representative verifies and clarifies information provided in the submitted accreditation documents through document review and interviews with key institutional and/or program personnel. 

Specialty program: A structured educational experience designed to comply with the Foundational and Advanced Specialty Requirements for a particular specialty. Also referred to as a residency program. 

Sponsoring Institution: The organization (or entity) that assumes the ultimate financial and academic responsibility for one or more graduate medical education programs, consistent with the ACGME-I Institutional Requirements. 

Subspecialty program: A structured educational experience following completion of a prerequisite specialty (residency) program in graduate medical education (GME) designed to comply with the Advanced Specialty Requirements for a particular subspecialty. A subspecialty, or fellowship, program usually functions in conjunction with, is sponsored by the same Sponsoring Institution as, and is in geographic proximity to its affiliated residency. 

Sub-subspecialty program: A structured educational experience following completion of a prerequisite subspecialty (fellowship) program in GME designed to comply with the Advanced Specialty Requirements for a particular sub-subspecialty. A sub-subspecialty fellowship program usually functions in conjunction with, is sponsored by the same Sponsoring Institution as, and is in geographic proximity to its affiliated subspecialty fellowship and specialty residency programs. 

Summative evaluation: See “Final evaluation” 

Supervising physician: A physician (faculty member, more senior resident, or fellow) 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. 

Supervision levels: See Foundational Requirement VI.D.3. 

Transfer resident: Residents are considered “transfer residents” under several conditions, including: moving from one program to another within the same or between different Sponsoring Institution(s) and within the same or a different specialty; when entering a program requiring a preliminary year at the PGY-2 level even if the resident was simultaneously accepted into the preliminary PGY-1 program and the PGY-2 program. 

The term does not apply to a resident who has successfully completed a residency and then is accepted into a subsequent residency or fellowship program. 

Transitional year program: A one-year educational experience in graduate medical education (GME), which is structured to provide a program of multiple clinical disciplines designed to facilitate the choice of and/or preparation for a specialty. The transitional year is a prerequisite; it does not comprise a complete program in GME. 

Work compression: An increase in the amount of work to be completed without a corresponding increase in the amount of time provided to complete that work.