Perspectives on the Single GME Accreditation System

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In his recent article, Dr. Cummings1 casts doubt on the ability of many American Osteopathic Association (AOA)-accredited graduate medical education (GME) programs to transition into a single GME accreditation system (SAS) during the 2015–2020 period allotted by the memorandum of understanding (MOU) signed by the AOA, the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education (ACGME), establishing the SAS. While his analysis draws some useful attention on the challenges that a narrow reading of AOA versus ACGME accreditation standards portray, it narrowly focuses on a few points, like program size standards, and does not accurately convey the full picture of the factors governing SAS transition, nor does it consider certain developments that have occurred since the MOU was signed.
Dr. Cummings forecasts much of the difficulty for AOA programs transitioning to ACGME accreditation based on the differing standards for the minimum number of residents required by the two accrediting bodies, and he cites several specialties—including family medicine and internal medicine—to make his point. For instance, he points out that “41% of AOA internal medicine programs in 2015 were approved for fewer than the ACGME’s minimum of 15 enrolled residents.”1 However, he fails to note a widely disseminated provision designed to address the historically smaller, community-based AOA-accredited residency programs: The ACGME will not deny accreditation based solely on program size or number of residents.2,3 It is disingenuous not to have noted this given the author’s heavy reliance on program size to buttress his argument.
Another notable inaccuracy is the author’s statement that hospital sponsors of transitional year programs under the ACGME are required to have two core residency programs, which, as he notes, is not always the case in AOA programs based in small community hospitals where only one core residency might exist, typically family medicine. However, although Dr. Cummings cites the reference, he does not point out the current requirement that one core residency program is sufficient to enable a hospital to sponsor a transitional year program.4
While this article draws attention to some of the issues facing the implementation of the SAS, it does a disservice by providing inaccurate information that may result in the suppression of seeking ACGME accreditation by AOA programs at the very time when it is important for them to engage in that process.
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