How to prepare for an ACGME site visit

Few events create more anxiety for residency leadership than an ACGME accreditation site visit. Whether you're preparing for initial accreditation, continued accreditation or an off-cycle review, understanding the process ahead of time can help your team feel more confident—and avoid last-minute surprises.

This guide walks through what family medicine residency programs can expect during an ACGME site visit, common accreditation outcomes and practical tips to help your program prepare successfully.

Every family medicine residency program must undergo Accreditation Council for Graduate Medical Education (ACGME) site visits to achieve or maintain accreditation.

During these visits, an ACGME field representative evaluates whether your residency program complies with accreditation requirements and verifies the information submitted in your application and Accreditation Data System (ADS).

While accreditation visits can be stressful, they're also an opportunity to demonstrate your program's strengths and commitment to continuous improvement.

Programs may receive site visits for several reasons, including:

• Initial accreditation
• Continued accreditation
• Off-cycle reviews prompted by concerns or significant program changes

For new residency programs, timing matters.

The Family Medicine Review Committee (RC) meets three times each year (January, April and October), and the committee's decision can directly affect when a new program is able to recruit its first class. For example, if you are trying to match a class as soon as possible, a January decision (late) or an April decision (post-match) can leave programs with only a few months to find qualified residents for a July start. Be sure to check the listed agenda deadlines on the ACGME site for Family Medicine prior to your submission to optimize the timing of your site visit and your Match strategy. Missing a submission deadline could even delay recruitment by an entire Match cycle.

For the purposes of this blog, we’ll focus on programmatic level site visits versus sponsoring institution (SI) site visits. Some FM programs will participate in both types of visits if they are sole programs; your Designated Institutional Official (DIO) is a good resource if you are scheduled to participate in an SI visit.

Launching a new residency program requires extensive planning. Before submitting an application, programs typically assemble:

• Specialty specific application
• Program policies
• Institutional policies
• Rotation goals and objectives
• Program letters of agreement (PLAs)
• Sample evaluations
• Block schedules
• Didactic schedules
• Other required supporting documentation

Expect the application process to take at least six months and involve several hundred pages of documentation.¹

Once the Review Committee approves your application, ACGME will ask for potential black-out dates and schedule a site visit—typically with about 30 days' notice—and assign an experienced field representative (occasionally two). The site visit may either be virtual or in person.

To prepare, update the Accreditation Data System (ADS) and make sure your team is familiar with the many acronyms used by the ACGME. To anticipate possible questions from the site visitor, review the list of the Top Citations in FM that is shared annually at the Residency Leadership Summitt by the Chair of the FM Review Committee.

The visit itself provides an opportunity for the field agent to interview members of your team and verify different aspects of your program. Make sure your team arrives on time and has no other commitments during their scheduled interviews. Site visitors have been known to ask Program Directors to edit block diagrams or ask to tour your FMP after the formal interviews are complete.

Following the visit, the site visitor submits a report to the Family Medicine Review Committee for review at an upcoming RC meeting. If the RC grants initial accreditation, the program’s next site visit for continued accreditation happens once the residency has started their first few classes.

Once your program has residents, the focus expands beyond documentation.

Resident interviews become one of the most important parts of the visit. Prior to the visit, resident and faculty representatives will be asked to submit consensus lists highlighting the program's top 5 strengths.

Fortunately, most family medicine residency programs receive favorable accreditation decisions.

If your program receives citations or Areas for Improvement (AFIs), don't wait until your next site visit to address them.Updating ADS throughout the year with your improvement plans demonstrates your program's commitment to continuous quality improvement and may help reduce future citations.

One of the most effective ways to prepare for expected and unexpected site visits is to practice.

A mock site visit allows your residency leadership team, faculty and residents to experience the process before the actual review. These can be conducted internally or via an experienced consultant.External consultants can identify documentation gaps, prepare participants for their interview, and offer practical recommendations based on previous accreditation visits.

AAFP's Residency Program Solutions (RPS) offers virtual and in-person mock site visit consultations led by experienced residency leaders who understand exactly what programs can expect during an ACGME review.

Preparing for an ACGME accreditation site visit can feel overwhelming, but it doesn't have to be.

Programs that stay organized, keep documentation current and practice ahead of time are often able to approach site visits with greater confidence. Rather than viewing the visit as a high-stakes inspection, think of it as an opportunity to showcase your program's strengths and your commitment to educating the next generation of family physicians.