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ACGME implements new process for Resident Surveys and duty hour violations

Residency Program Connection, September 30, 2008

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The ACGME last week released a special announcement that outlines standardized processes for handling potential duty hour violations, revealed by the Resident Survey and for improving Residency Survey completion rates, according to a Sept. 18 announcement. The document, titled “Standard Approach to Programs Across All Specialties with Potential Duty Hour Violations Identified in the Resident Survey,” says the ACGME board of directors adopted these standards for all specialties. Here’s a break down of the new procedures:

Response rate of the Resident Survey: The report spells out the actions the ACGME will take if 70% of a program’s residents fail to complete the Resident Survey. Under the new protocol, the following repercussions will occur if the program does not attain a 70% completion rate:

• ACGME sends a warning letter to the program director and a copy to the designated institutional official (DIO)
• All residents in the program must take the survey again the following year
• If  the program does not meet the 70% threshold, the program is surveyed again the following year
• If the program does not meet the 70% mark, the board of directors will contemplate administrative withdrawal of the program

Reports of duty hour violations on the Resident Survey: If the Resident Survey reveals potential duty hour violations, the ACGME will take the following steps:

• ACGME sends the program and DIO a warning letter explaining that residents must take the survey again the following year, and violations should be corrected within this timeframe  
• If the program does not correct the duty hour problems and the second Resident Survey indicates violations, the ACGME will conduct a site visit within the subsequent nine months
• The ACGME Institutional Review Committee is notified of the program site visit results, and the committee will take action on the institutional level
• Residents take the survey again the following year
• If residents report duty hour violations on the Resident Survey, the ACGME will conduct a full site visit and issue a report within six months
• Concurrently, the ACGME will conduct an institutional site visit and also issue its findings within six months

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