Criteria for Excellence | Chapter 6A: Sponsoring institution

A strongly supportive relationship between a residency program and its sponsoring institution (SI) is essential to the success of the program. The accreditation expectations and responsibilities defined by the Accreditation Council for Graduate Medical Education (ACGME) in its Institutional Requirements​ recognize the critical nature of this relationship for both quality training of residents and program stability. A Program of Excellence exists in an environment in which the SI explicitly identifies education as a core part of its mission.

The Institutional Requirements emphasize the sponsor’s responsibility to provide adequate financial support and other resources to its programs, as well as to oversee the learning and working environment for all sites where its residents work. The Common Program Requirements further underscores the importance of integrating learners into key institutional initiatives, including patient safety, health care quality with additional focus on addressing health disparities, professionalism, well-being, and teaming (formerly transitions in care). It also emphasizes the need to ensure compliance with supervision standards and a robust approach to supporting learner well-being.

A Program of Excellence is able to describe—at least in qualitative terms—the impact of its education and service on the environment of the community, hospital, and medical staff. This analysis of community needs and the residency program’s impact, including how it will reduce disparities, is significant in shaping the program’s strategic plan, goals and objectives.

The following structural and organizational elements and resources are essential to a Program of Excellence:

The SI for a Program of Excellence demonstrates consistent and strong support for the program’s mission, goals, and strategies to promote excellent GME in a patient care setting that embraces the Quadruple Aim and advances health equity (an expanded framework sometimes referred to as the Quintuple Aim). Each participating institution should complete a program letter of agreement emphasizing its support of these goals and strategies.

Educational programs and the institutions in which patient care is practiced and modeled are integrally entwined on multiple levels, including the following:

In an increasingly complex and financially stressed environment, collaboration between institutions and programs is critical to maximizing mutual success. These collaborative measures include the following:

1. The SI and the Program of Excellence must mutually commit to regular, open communication and shared strategies in support of medical education and excellent family medicine-based patient care.
2. Program leadership must present an update at least annually to institutional leadership, including the board of directors, on the value of the program and the return on investment to the community and the institution.
3. The SI must meet ACGME requirements for institutional accreditation, with a particular commitment to providing strong support for educational and clinical resources, including space, staff, visibility, and competitive salaries and benefits for faculty, residents, and staff.
4. The Designated Institutional Official (DIO) must be empowered within the sponsoring organization to effectively represent the needs of its sponsored programs and negotiate for needed resources in support of the programs. Program directors should have direct lines of communication with the DIO to collaborate in these efforts.
   1. Time required for the DIO role will depend on the number of programs sponsored by the institution, including both residency and fellowship programs. It will also depend on whether the institution has long-standing accreditation or is newly accredited because establishing all the systems and processes for a newly accredited institution requires significant work effort. Administrative support for the DIO is essential tofulfilling the job responsibilities and coordination functions.
   2. In some institutions, the DIO may be one of the program directors. Although this arrangement can work in principle, an institution should only enact this dual role after careful analysis. It may make effective advocacy for the needs of the GME programs more challenging by reducing the number of champions with significant roles in organizational leadership, and it may add substantial responsibilities for which time would be taken away from PD duties. Additional institutional staff support would also be mandatory, beyond program administrative support.
   3. If the program director serves as DIO, there are conflicts of interest that are concerning. The DIO and GMEC must review and sign off on a residency program’s Annual Program Evaluation. This requirement is intended to ensure institutional input in addition to that of the PD. All AGCME and Review Committee for Family Medicine (RC-FM) responses to concerns, warnings, and citations must be reviewed and approved by the DIO to ensure a “second set of eyes” on these responses. Additionally, in most institutions, the DIO is part of the appellate process for adverse resident personnel decisions such as probation and termination; obviously, the PD cannot fill an appellate roll in the grievance process.
   4. Thus, Residency Program Solutions (RPS) recommends that Programs of Excellence separate the program director and DIO roles, whenever possible, and provide specific unique support for the DIO. In addition to the need for adequate protected time to perform DIO duties, RPS has found that having two GME leaders working together in support of a residency program ensures alignment with the sponsoring institution’s mission, vision, and goals to best support programs aiming for excellence. RPS further recommends specific, dedicated administrative support that is distinct from program administrative support. For institutions that are Single-Program Sponsoring Institutions (SPSIs), such as those in which the family medicine program is the only one sponsored, RPS specifically recommends that Programs of Excellence should have leadership staffing of a minimum of 0.1 full-time equivalent (FTE) for the DIO role; newly accredited SPSIs should have an additional 0.1 FTE until the program is fully mature. In addition, RPS recommends the same FTE level for dedicated institutional administrative support staff.
5. The GMEC is empowered with significant oversight responsibilities for the institution’s GME programs and has a mandate to ensure the quality of the learning and working environment for graduate training at all participating sites. The potential importance of this committee in supporting GME programs cannot be overemphasized. However, the degree to which the GMEC actually fulfills its responsibilities varies among institutions.
6. The GMEC can play an important role for its programs, particularly if membership is recruited from key “influencers” from the medical staff and administration. Discussions within the GMEC can enhance understanding of GME processes and more materially integrate GME residents and faculty into systems. The GMEC can also include residents and fellows as essential voices in institutional planning and create a groundswell of pride and ownership in the programs to help ensure ongoing support from institutional leadership and the broader medical, nursing, and administrative staff.
7. Sponsoring and participating institutions should be involved in developing and reviewing the family medicine residency program’s philosophy, vision, core values, and mission statement, as appropriate. Education must be a distinct part of the SI’s mission and/or vision and be articulated clearly in its formal mission and/or vision statements.

References

1. Accreditation Council for Graduate Medical Education. ACGME Institutional Self-Study. February 2020. Accessed August 22, 2022.
https://www.acgme.org/globalassets/PDFs/SelfStudy/Institutional-Self- Study-
Overview.pdf​